This article is more than 5 years old. Information may no longer be current.
Ace the Case: A 50-Year-Old Woman Presents with Joint Pain
Click Here to Manage Email Alerts
A 50-year-old woman presents for evaluation of joint pain. She was diagnosed with rheumatoid arthritis (RA) 2 years prior. At that time, she had pain and swelling over multiple metacarpal and proximal phalangeal joints, as well as through the midfoot bilaterally. She had a positive rheumatoid factor (RF) at 86 units/mL and anti-cyclic citrullinated peptide (CCP) antibody at over 250 units. Methotrexate (MTX) 15 mg PO weekly was initiated. Her other medical history is significant for hypertension, for which she takes hydrochlorothiazide (HCTZ). Additionally, she has an allergy to sulfa, she smokes half a pack of cigarettes daily, and drinks six beers per week.
She improved on MTX, but continued to have high disease activity after 3 months, at which time adalimumab—a TNF inhibitor— 40 mg every 2 weeks was added to MTX. She reached a state of low disease activity. However, after 1 year of treatment, she developed a persistent elevation in liver function tests (AST 70U/L, ALT 60U/L), which led to the discontinuation of MTX. She developed worsening pain and over an hour of morning stiffness, prompting return for reevaluation. Her exam reveals four swollen and six tender joints. Labs show a CBC and BMP within normal, AST and ALT slightly elevated at 45 U/L and 35 U/L respectively, CRP 2 mg/dL, and ESR 50 mm/hr. The X-rays of the hands and feet do not show erosive changes.
Click here to view this activity.
Learning Objectives:
Upon completion of this educational activity, participants will be better able to assess treatment options in patients with rheumatoid arthritis.
Overview
Author(s)/Faculty: Michael J. Lucke, MD
Source: Healio Rheumatology Education Lab
Type: Monograph
Articles/Items: 4
Release Date: 1/15/2018
Expiration Date: 1/14/2019
Credit Type: CME/ABIM MOC
Number of Credits: 0.25
Cost: Free
Providers: Vindico Medial Education
CME Information
Provider Statement: This continuing medical education activity is provided by Vindico Medical Information.
Support Statement: There is no commercial support for this activity.
Target Audience: The intended audience for this activity is rheumatologists and other health care professionals involved in the treatment of rheumatoid arthritis.