Differential Diagnosis for Mrs Patrick and Give Case Study

Excerpt from Case Study :

differential diagnosis for Mrs. Patrick and give the most likely probable diagnosis.

A review of the case reveals that Mrs. Patrick could be suffering from Fibroblastic rheumatism, Rheumatoid Arthritis, Sarcoid arthropathy, Acute viral polyarthritis or Rheumatoid Arthritis.

Fibroblastic rheumatism is noted by Chkirate and Job-Deslandre (2001) to be a very rare disease of an unknown etiology. It however shares certain features of arthritis, nodules as well as arthraglia. The disease causes flexion contractures in most of the patients, a symptom which Mrs. Patrick lacks. In half the cases, thickened palmar fascia is presented.

Sarcoid artropathy

This is a chronic arthritis in the sarcoidosis and it may be polyarticular or oligoarticular. In most cases, it presents itself similarly to RA.In most cases it affects knees, hands, ankles and wrists as well as interphalangeal joints and metacarpophalangeal. It is also normally associated with parenchymal pulmonary disease.It is distinguished from Rheumatoid Arthritis by:

The elevated concentration of angiotensin converting enzyme (ACE) in the serum

Chest radiography may show elements of sarcoidosis.

Acute arthritis pattern together with Lofgren's syndrome in the patients is never observed in RA cases.

Acute viral polyarthritis

This may be caused by a wide rage of viruses such a rubella (Smith, Petty, Tingle, 1989) HBV and parvovirus B19 (Smith, Woolf, Lenci,1987).Serologic testing can be used in the identification of the viruses in patients.


The patients has Rheumatoid Arthritis due to the fact that she presented its most common symptoms as well as a genetic link (Vossennar,2004) (mother had it).

2. Give an explanation of the pathological process involved to produce the signs and symptoms of Mrs. Patrick

According to Vitali et al. (1999) the pathological process in RA starts with the presentation of a relatively unknown antigen for 'rheumatoid' by an antigen presenting cell to the CD4 +T cell receptors. The second step is the activation of CD4 +T cell and then of the cytokine network. This then leads to the development of the signs and symptoms.

3. Mrs. Patrick is concerned that her condition may have some serious complications to her health. Explain how the family history and personal history of the patient is relevant to her present condition and what complications may develop from this condition?

Rheumatoid Arthritis is noted to have a genetic link (Vossennar,2004). The genetic link could be the one that has caused the disease to be present in Mrs. Patrick since his mother also had the disease.The patients personal history is also important since the disease could be caused by certain injuries and health conditions.The complication which may arise from her condition include atherosclerosis, myocardial infarction (heart attack),stroke, endocarditic,, pericarditis and Pulmonary heart disease.

4. Suggest the further investigation tests to confirm your diagnosis and explain what findings to you expect from these tests.

Antinuclear antibody (ANA) testing

A negative antinuclear antibody (ANA) testing effectively excludes systemic lupus erythematosus (SLE) as well other forms of systemic rheumatic diseases. The Antinuclear antibody (ANA) tests may be positive for 75% of the RA patients. In those with positive negative antinuclear antibody (ANA) test, anti-Smith antibody and anti-double stranded DNA testing must be performed.

Complete blood count (CBC)

Complete blood count (CBC) with both platelet and differential count, kidney function, test of liver, urinalysis as well as serum acid. The complete blood count (CBC) is usually abnormal in patients with RA. Thrombocytosis and anemia consists of very chronic inflammation.


Radiographs of the feet, hands and wrists can be used at the time of the initial evaluation as a baseline used form monitoring for the progression of disease. Join erosion characteristics may be observed in RA patients.

5. Discuss the management option for this patient

The management options include the use of medication (Pharmacothherapy) (disease-modifying antirheumatic drugs ) (Rindfleisch and Muller,2005). The pharmacotherapy alternative involves the use of nonsteroidal anti-inflammatory drugs (NSAID) necessary for the control of pain as well as a selective application of low-dose oral as well as intra0articular gkucocorticoids.

Nonpharmacologic treatments

There are a number of nonpharmacologic treatments that can be used in the management of rheumatoid arthritis. Some of these include therapeutic fasting, spa therapies, dietary supplementation of the very essential fatty acids, exercise as well as journaling. Short-term benefits can be achieved…

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