A 45-year-old female comes to the physician with joint pain, swelling and morning stiffness which improves with use. She also reports weight loss of 3 kg (6.6 lbs). Laboratory tests reveal the presenc

Question

Options

• Acomplete blood count
• Belectrocardiogram
• Cliver function test
• Dpurified protein derivative test
• Ethyroid function test

• A
  4% (1)
• C
  4% (1)
• D
  78% (18)
• E
  13% (3)

Explanation

This patient most likely has rheumatoid arthritis (RA) which is an autoimmune disease characterized by inflammation and erosion of articular cartilage and bone. It presents with weight loss, fatigue, joint pain, swelling and morning stiffness which lasts longer than an hour and improves with use. It usually involves the metacarpophalangeal joints, proximal interphalangeal joints and the wrist joints. Joint findings include soft tissue swelling, joint space narrowing and subchondral cysts. Management of RA includes treatment with NSAIDs, glucocorticoids, methotrexate, hydroxychloroquine and biologic agents like TNF-alpha inhibitors such as etanercept. Etanercept is a fusion protein which comprises of a decoy receptor for TNF-alpha and the Fc portion of IgG. It is produced by recombinant DNA and approved for use in rheumatoid arthritis, psoriasis and ankylosing spondylitis. TNF-alpha inhibitors predispose patients to developing tuberculosis due to the reactivation of latent TB hence a purified protein derivative (PPD) test is required before etanercept is prescribed.

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