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 Best of Five 2.37

 

   

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BOF 2.37

A 52-year-old female presents with pain and swelling of her wrists and hands of 6 weeks duration. She complains of about one and a half hours of stiffness in the mornings. She says her mouth is dry and her eyes feel gritty. She also complains of fatigue and being generally unwell. No past illnesses of note. On examination she has rheumatoid nodules, there is a bilateral, symmetrical arthropathy mainly affecting the metacarpophalangeal and proximal interphalangeal joints.  Schirmerís test is positive.

Investigations reveal:

Hb 10.5 g/dL

MCV 90 fL

ESR 60 mm in 1St hour

Rheumatoid factor 60 k IU /L

In this patient:

a)      The presence of rheumatoid nodules precludes the use of methotrexate

b)      Early introduction of DMARDs (Disease Modifying Anti Rheumatic Drugs) would enable an improved outcome

c)      NSAIDs and paracetemol should be given for an extended period to enable least exposure to toxic second line agents

d)      Sicca syndrome rules out the use of sulphasalzine

e)      Symptom control with low dose prednisolone would be the treatment of choice

 

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