Rheumatoid arthritis: Differentiating between forms of crippling arthritis

Emma, a 32-year-old with existing foot and hand pain, visits her healthcare provider after hand pain, neck stiffness, and worsening fatigue over the last three months.

Emma’s healthcare provider conducts a full clinical history and physical examination and decides to test for rheumatoid arthritis.

Emma is experiencing joint pain and fatigue. See how serological testing can help confirm a diagnosis of rheumatoid arthritis.

Patient History

Family History

Mother has unknown form of crippling arthritis.

Emma's Personal History

Localized pain in knuckles of hand and pads of feet.
Ibuprofen helps some, and acetaminophen does not.
Imaging: Marginal erosions were detected on radiographs.
Physical examination: Normal with the exception of the hands, which were tender when palpated over the second and third proximal interphalangeal joints.

Emma’s Test Results

These results together with this patient's case history and symptoms, help confirm the diagnosis.

Interpretation of Test Results
Type	Emma's Results
CBC, Chem7, Liver Function Tests	Urinalysis normal
Anti-dsDNA	Negative
Anti-CCP	Positive
RF IgM	Positive
RF IgA	Positive

Differential Diagnosis

REFINED DIAGNOSIS

Inflammatory arthritis, rheumatoid.

HEALTHCARE PROVIDER MANAGEMENT PLAN

Steroids and methotrexate initially.
Biologics or triple therapy if inadequate response.
Follow up every eight to 12 weeks in the beginning to assess therapies and monitor lab work.
Healthcare provider visits may extend to every three to six months if well controlled.

The people, places, and events depicted in these case studies and photographs do not represent actual patients, nor are they affiliated in any way with Thermo Fisher Scientific.

References

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