Eighteen years ago, A.B. complained to her

Eighteen years ago, A.B. complained to her PCP of multiple rashes that developed on her arms and legs whenever she went out into the sun. She also complained of several small patches of hair loss on her head that she attributed to stress and an airplane trip that she took three months previously. Flying terrifies her. Furthermore, she mentioned at that time that she lacked energy, became tired very easily, and always needed to take at least one nap each day. She was also suffering from mild arthritic pain in her fingers and elbows but attributed the joint discomfort to “growing old.” Her ESR was 25 mm/hr. Question 3: Explain the pathophysiology that underlies hair loss in this patient and the relevance of the abnormal ESR? Question 4: What might have caused the lack of energy in this patient, and what type of tests might be ordered to support this conclusion? 2. Five years ago, A.B. presented again to her PCP, this time complaining of a productive cough and stiffness and pain in her hands and feet that seemed to come and go and to affect different joints (migratory polyarthritis). She is afraid that she is developing rheumatoid arthritis like her older sister. Question 5: It is appropriate for her PCP to inform her that: she clearly is showing signs of rheumatoid arthritis and probably has it. the arthritis of lupus, which is a likely possibility, is relatively benign, unlike rheumatoid arthritis, which destroys cartilage in the joints and causes deformities. the pain she is feeling in the joints is probably due to getting older and wear and tear (a condition known as degenerative joint disease) and is not likely related to her condition. the pain that she is feeling in her joints is most likely the result of gout, and a serum uric acid test is appropriate.

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