Reference no: EM133275569
Assignment:
Case Study: Joint Disorders
After reviewing the case, please provide answers to the questions that follow.
ET is a 45yo 100 kg male who was referred to a rheumatologist by his PCP with complaints of bilateral joint pain and swelling in his proximal interphalangeal joints, metacarpals, and wrists of both hands for the last 3 months. He also has a red painful right knee. He has a history of high cholesterol and hypertension. He reports that he had an acute gouty arthritis attack 6 months ago that was treated with 5 days of naproxen. His PCP had hand and foot x-rays done, and there are no joint erosions present.
He is on the following medications: acetaminophen XR 650mg TID and Lisinopril-HCTZ 10mg-12.5mg once daily and has no drug allergies. He drinks one 12oz beer daily (with more on Saturdays).
His PCP drew the following labs:
- wbc 3.6, hgb 11.4, plt 238
- Serum creatinine 0.9, normal liver function tests
- Rheumatoid factor +IgM
- C-reactive protein 1.2 (normal range 0-0.5)
- Erythrocyte sedimentation rate 35 (normal range <20)
- Serum uric acid 7.5 (male normal range 3.5-7.8)
What symptoms does he have that classify him as having definite RA? What labs are inline with a diagnosis of RA?
It is determined that ET has early RA with moderate activity (he has rheumatoid nodules along some of his hand tendons). What medication(s) should he be started on?
Are there any other tests, labs, or other information that you would like to have to safely prescribe the medication(s) in #2?
List at least 5 adverse effects of the medication(s) recommended in #2
What patient education (focusing on safely taking the medication in #2, adverse effects, possible drug interactions) would you provide to him about the medication(s) selected in #2? Please make sure that education is in lay terms.
ET's RA symptoms improve significantly with the drug therapy in #2 after several months. He is very happy with his treatment. On his most recent lab work, you note the following changes:
Serum creatinine 1.0 and uric acid 10.0 with normal LFTs and CBC. He denies having any acute gout attacks recently. What non-pharmacologic measures can you recommend lowering his serum uric acid and decrease the likelihood of future gout attacks?
Three months later, ET has a gout flare in his big toe. What drug therapy do you recommend decreasing the pain of the gout flare and why did you select this medication over other options? What is the mechanism of action for your recommended medication?