PBL A
CASE 2
• Alisa Varghese
• MEDF23-5
CASE DESCRIPTION
Patient name : Emma
Age : 46-year-old
Family :married mother of two children
Occupation: active lifestyle, part-time
hairdresser
Complaint: Extreme shoulder pain, unable to
lift arms
History of stiffness in hands, wrists, and
MEDICAL HISTORY
• Symptoms started 8 months
ago with morning stiffness
• Difficulty standing due to
foot and ankle pain
• Progression to shoulder
pain, fatigue, and irritability
• Limited relief from ibuprofen
TESTS
• Vital signs: Normal pulse,
blood pressure,
temperature
• Laboratory findings: Anemia
(Hb 11.2g/dl),
• Elevated WBC count,
Elevated ESR and CRP,
Positive anti-CCP antibodies
• Physical examination:
Bilateral joint swelling,
redness, tenderness in
hands, wrists, and ankles
POSSIBLE DIAGNOSIS
RHEUMATOID ARTHRITIS OSTEOARTHRITIS
• X-rays of affected joints for joint
damage assessment
FURTHER TESTS
• Ultrasound or MRI for soft tissue
and joint inflammation
• Rheumatoid factor (RF) test for
confirmation
RHEUMATOID ARTHRITIS
• What is Rheumatoid Arthritis?
• Rheumatoid Arthritis (RA) is a chronic
autoimmune disorder that causes
inflammation and pain in the joints -
• The body's immune system
mistakenly attacks the lining of the
joints, leading to swelling, stiffness,
and loss of function
• Symptoms
• Joint Pain and swelling - Morning
Stiffness - Fatigue - Loss of Function -
Fever - Weight Loss - Cysts - Deformity
OSTEOARTHRITIS
• What is Osteoarthritis?
• - Osteoarthritis (OA) is a degenerative joint disease -
• Wear and tear on joints causes cartilage to break
down - Bones rub against each other, causing pain,
stiffness, and limited mobility
• Symptoms: -
• Joint pain or aching (especially after activity) -
Stiffness (especially after rest)
• Limited mobility or flexibility -
• Creaking or cracking sounds when moving the joint -
• Swelling or tenderness around the joint
• Loss of joint function or deformity (in severe cases)
• Causes: - Aging (most common cause) - Joint injury
or trauma - Overuse or repetitive strain - Obesity
(increases stress on joints) - Genetics (family history)
- Poor joint alignment or biomechanics
PHYSICAL EXAMINATION
• Joint Inspection
• (Hands, Wrists, Ankles, Feet, Shoulders): Visual
inspection and palpation of joints for signs of
swelling, redness, tenderness, deformities, or
warmth.
• Range of Motion Assessment
• Evaluation of joint mobility and flexibility,
including active and passive movements to
assess limitations in joint function.
• Palpation
• Manual examination technique involving the
use of touch to assess for tenderness, swelling,
or abnormalities in joint structures and
surrounding soft tissues.
OSTEOARTHRITIS VS RHEUMATOID ARTHRITIS
HYPOTHESIS CONFIRMATION
• Rheumatoid Arthritis (RA): • Osteoarthritis (OA):
• Symptoms: Bilateral joint involvement • Symptoms: Unilateral joint
Morning stiffness lasting more than 30 involvement Symptoms worsen with
minutes Systemic symptoms such as activity and improve with rest
fatigue and weight loss Laboratory • Physical Examination: Bony
• Tests: Elevated inflammatory markers enlargement (osteophytes) Crepitus
(ESR and CRP) Positive anti-CCP Imaging Studies: X-rays may show
antibodies Physical Examination: joint space narrowing, osteophyte
Bilateral joint swelling, redness, and formation, and subchondral
tenderness Presence of synovitis and sclerosis
joint effusion
• Imaging Studies: X-rays and MRI may
reveal joint erosion, synovitis, and soft
tissue inflammation
CONFIRMATION RESULT
• Symptoms consistent with Rheumatoid Arthritis (RA):
• Emma presented with bilateral joint involvement, including hands, wrists, ankles, and shoulders.
• She reported prolonged morning stiffness lasting more than 30 minutes, indicative of RA.
• Systemic symptoms such as fatigue and lack of energy were also observed.
• Laboratory Findings Supporting RA Diagnosis: Elevated levels of inflammatory markers,
including ESR and CRP, were noted in Emma's blood tests.
• Positive presence of anti-CCP antibodies, highly specific for RA, further supports the diagnosis.
• Physical Examination Findings Consistent with RA: Bilateral joint swelling, redness, and
tenderness were observed during the physical examination.
• Presence of synovitis and joint effusion confirmed during examination aligns with RA.
• Conclusion: Based on Emma's clinical presentation, laboratory results, and physical examination
findings, rheumatoid arthritis (RA) is confirmed as the diagnosis in this case.
TREATMENT AND OUTCOME
• Nonsteroidal anti-inflammatory
drugs (NSAIDs) for pain relief
Disease-modifying antirheumatic
drugs (DMARDs) to slow disease
progression
• Physical therapy for joint
flexibility and strength
• Regular follow-ups to monitor
disease activity and adjust
treatment
PROGNOSIS
• Prognosis varies, but early
diagnosis and treatment
improve outcomes
• RA is a chronic condition
requiring lifelong
management
• Joint damage and disability
can be minimized with proper
care
REFERENCES
www.ncbi.nlm.nih.gov
www.mayoclinic.org
www.onhealth.com
www.medicinenet.com
