Using the principles of the 2017 NSFCC (Part 2, Objective

Sarah Jones, a 62-year-old female, has been diagnosed with rheumatoid arthritis (RA), a chronic autoimmune disorder primarily affecting the joints. RA is characterized by persistent inflammation, which Sarah has been experiencing as joint pain in her fingers, wrists, and hips, along with morning stiffness lasting over an hour. These symptoms are indicative of the disease’s progressive nature, leading to difficulty in daily activities such as buttoning clothes and buttering toast. The pathophysiology of RA involves the immune system mistakenly attacking the synovium, the lining of the joints. This autoimmune reaction triggers the release of pro-inflammatory cytokines like tumor necrosis factor (TNF) and interleukin-6 (IL-6), which promote inflammation and lead to the thickening of the synovium, forming a pannus. The pannus invades and erodes cartilage and bone, causing joint damage, deformity, and immobility. In Sarah’s case, her blood tests showed elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels, indicating systemic inflammation. Additionally, the presence of rheumatoid factor (RF), anti-citrullinated peptide/protein antibodies (ACPA), and autoantibodies confirmed by ANA results, along with genetic predisposition (positive HLA-DRB1), further supported the RA diagnosis. Her x-rays revealing mild deformities in the proximal interphalangeal joints confirm the joint damage typical of RA. Sarah is 162 cm tall, 69 kg with a BMI of 26.3 kg/m2. Her vital signs are: temperature 36.4⁰ C, heart rate 74 beats/min, respiration rate 16 breaths per minute, blood pressure 128/84 mmHg. Blood tests were conducted to check her full blood count Antibody tests were conducted to determine Sarah’s rheumatoid factor and anti-citrullinated peptide/protein antibody levels as well as an antinuclear antibody (ANA) assay. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were both elevated. Rheumatoid factor (RF) and anti-citrullinated peptide/protein antibodies (ACPA) were both positive. ANA results confirmed presence of autoantibodies. Genetic testing is positive for human leukocyte antigen DRB1 (HLA-DRB1) X-rays were taken of Sarah’s hands which indicate a mild deformity at numerous proximal interphalangeal joints of the fingers on both hands. Considering Sarah’s health history, risk factors, clinical manifestations, blood, antibody and genetic test results, and her x-ray she was diagnosed with rheumatoid arthritis. Sarah saw a rheumatologist who has prescribed methotrexate, 15mg orally once weekly. She has also been recommended to take 1mg folic acid orally once a day, except the same day as taking methotrexate, due to the effects of methotrexate on folic acid function. Image transcription text Question 4: Explain what is happening in the body to cause Sarah’s decreased range of movement in her fingers. One Paragraph (200 £ 10%) Conten… Show more

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