Rheumatoid Arthritis Case Study

Understanding the disease called rheumatoid arthritis is best understood from the point of view of a patient. To protect privacy, no names are being used and this case study is a combination of several different patients. We’ll call our patient Jane Smith.

Jane is a 34 year old real estate broker who has noticed a 15 pound weight loss over the last six months although she is not dieting. At first she was pleased to lose a few extra pounds but now people are starting to comment that she looks too thin. She has also noticed that she is tired all the time and has had a lot of problems with an upset stomach. She has assumed it was acid indigestion and has been taking over the counter antacids without much success. For the last three weeks she has felt very stiff on awakening and this has lasted for at least the first two or three hours a day.

Since she needs to use the computer extensively and needs to walk a great deal to show properties, the stiffness has impacted her work. On weekends, she has also felt too tired to play tennis or to jog as usual. Jane noticed this week that some of her hand and finger joints are swollen and feel warm to the touch. A coworker who knew what she was experiencing said it sounded like her mother in law, who has rheumatoid arthritis.

Jane’s only close contact with rheumatoid arthritis or RA was an aunt who was very disabled from the disease and who had been confined to a wheelchair. She had hands so damaged that someone had to cut her meat for her and her feet required specially made shoes, so Jane was very frightened that she could end up as bad off as or even worse than her aunt.

Jane made an appointment with her family doctor who agreed that her symptoms could be RA and who ordered some blood tests and x-rays. He asked a number of questions about her symptoms and counted the number of swollen and tender joints she had, noticing that they were symmetrical. He told her that RA was only one possible diagnosis and that treatment now is much better than in her aunt’s day. She was given an appointment with a rheumatologist a few days later when the blood work results would be back.

Jane was told at her appointment that the combination of her age, symptom score and test results did indicate she had rheumatoid arthritis in a fairly early stage with no damage yet to her joints. Her RF or rheumatoid factor was positive as was a new and more specific test, the anti-CCP. While she could have been given only one agent to treat her early case, her doctor believes in aggressive treatment to achieve remission as quickly as possible to prevent damage and crippling. He discussed the risks and benefits of therapy and started her on an anti-inflammatory medication, a biologic response modifier and a disease-modifying anti-rheumatic drug.

He also reassured her that RA is a manageable disease for most patients and the odds were about 90% that she could lead a normal life. He also told her that Ra does not shorten your life. Six weeks later at her follow-up appointment, Jane felt much better and was surprised when the doctor increased her dosage on some of her medications. He explained that her blood work showed she was not yet in remission despite her feeling so well.

Six weeks later, Jane had normal blood work and all of her unusual symptoms had resolved. She continued on the same medications for a few months and then was switched to a maintenance protocol. Two years later she had a flare and was aggressively treated once again and went into remission again quickly. While she is not cured, Jane leads a normal and active life and has no joint deformities or stiffness. She has married and with her doctor’s blessing will go off some of her meds to try to have a baby.

While Jane is a mythical patient, this experience is much like that of many real patients. Like Jane, about 75% of new RA patients are women and most are in her age range from 30 to 50. Fortunately, also like Jane most RA patients will do well on state of the art medications and physical therapy and lead equally happy lives. For the few who are hard to treat, research continues to find new drugs and eventually a cure.

Resources

A case study in early RA:

www.immunologyclinic.com/case.asp?chap=10&case=2

Case study using a biologic response modifier to treat RA:

www.immunologyclinic.com/CaseIndex.asp

Exercise as part of RA treatment:

www.vhct.org/studies.htm

Several cases of typical RA presentation:

www.arthritispractitioner.com/article/7685

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