BOF: 2.12
A 45-year-old female presents with
a 2-month history of slowly progressive pain, stiffness lasting more than half
and hour in the morning and swelling of the joints of her fingers and wrists.
She feels generally unwell with early afternoon fatigue and malaise. On
examination she appears to have lost weight, there is swelling of her
metacarpophalangeal joints and the proximal interphalangeal joints.
Investigations reveal
Hb 10.0 g/dL
MCV 95 fL
ESR 70 mm in the 1st
hour
Rheumatoid Factor: 50 k IU/L
The features that would suggest
that this patient has a worse than average prognosis are:
a)
Female patient, gradual onset over a few months, positive IgM
rheumatoid factor, anaemia
b)
Early afternoon fatigue and malaise, loss of weight, high ESR,
normocytic anaemia
c)
Involvement of metacarpophalangeal joints, morning stiffness, positive
rheumatoid factor, high ESR, anaemia
d)
Loss of weight, involvement of metacarpophalangeal joints, positive IgM
rheumatoid factor, anaemia, high ESR
e)
Fatigue and malaise, positive IgM rheumatoid factor, anaemia, high ESR
Answer:
a)
The clinical features suggest the
patient has rheumatoid arthritis. In rheumatoid arthritis a worse than average
prognosis may be predicted with 80 % accuracy if the patient is female, a
gradual onset over a few months, positive IgM rheumatoid factor and or anaemia
within 3 months of onset
Rheumatoid Arthritis
