Juvenile Rheumatoid Arthritis Essay
A 10 year old girl, Sarah, is brought to your office by her mother, with complaints of right knee pain. It began about 6 weeks ago and Sarah denies recent illness, injury or fever. Her knee pain is worse first thing in the morning, but by lunchtime she is a little better. There is no known history of trauma. Past medical history is unremarkable. Family history is non contributory. PE reveals slightly overweight African American female appearing to be stated age.In no acute distress. Right knee is warm to touch and tender to palpation with loss of visual landmarks. Juvenile Rheumatoid Arthritis Essay
1a. What is your Dx and Management strategy for this client? Be prudent when ordering tests as inappropriate testing will cause a deduction in points. Include the 3 most likely DDX for this client with rationale.Juvenile Rheumatoid Arthritis Essay
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Potential differential diagnoses for this patient include: systemic lupus erythematosus (SLE), Lyme disease and juvenile rheumatoid arthritis (JRA). However, 95% of SLE cases commonly occur in women of childbearing age although children can also be affected. However, fever, a positive family history of SLE and the involvement of the mucocutaneous which the patient didn’t report of are a mandatory occurrence, which rules out the possibility of SLE (Schempp, et al., 2019). Lyme disease is primarily characterized by a gradual expansion of the erythema migrans which appears after some days at the tick bite site. Repeated episodes of swelling and joint pain reportedly occur within months-years later (Schempp, et al., 2019). However, the patient neither reported of a tick bite in previous months or years, which reduces the likelihood of diagnosing Lyme disease.Juvenile Rheumatoid Arthritis Essay
Therefore, the most likely diagnosis for this patient is juvenile rheumatoid arthritis since it is characterized by extra-articular involvement. Juvenile rheumatoid arthritis occurs in 5 of every 1000 children. Without the appropriate treatment, juvenile rheumatoid arthritis can lead to continuous disability and socio-economic challenges (Hefti, 2015). Since it typically affects the joints, it causes them to be painful, warm and swollen especially early in the morning upon waking up or occasionally during the day following prolonged inactivity. The level of severity, pain and stiffness however reduces as the day progresses just as reported by the client. Besides, based on the fact that the client was slightly overweight, it can be considered that the excessive fat was a source of inflammatory cytokines which led to a constant low-grade inflammation of the entire body (Hefti, 2015).
The tests that shall be ordered for this client include: rheumatoid factor and ACPA test (Anti-citrullinated protein antibodies) which is expected to turn out to be positive. However, a negative outcome will not necessarily rule out rheumatoid arthritis but will only be considered as seronegative (Giancane et al., 2016). A complete blood count and ESR rate will also be ordered. In patents with rheumatoid arthritis, the CBC usually has a low count of the red blood cells, a low HB level, low iron and a high WBC count following joint inflammation. Another specific test to order is an X-ray of the right knee which should reveal osteopenia, a joint space that is smaller than normal and swelling of the soft tissue (Giancane et al., 2016).
The goal of management will be to assist the child to maintain normal levels of social and physical activity. First, NSAIDs preferably ibuprofen will be prescribed to reduce pain and swelling of the joint. NSAIDs will be taken together with methotrexate, which is a DMARD (Disease-modifying antirheumatic drugs) to help slow the progress of JRA (Giancane et al., 2016). In the course of therapy, the child will be closely monitored for any adverse effects especially liver and renal problems. The child will be recommended to work closely with a physiotherapist to ensure that joints are kept flexible and their range of motion is also maintained (Giancane et al., 2016).Juvenile Rheumatoid Arthritis Essay
References
Giancane, G., Consolaro, A., Lanni, S., Davì, S., Schiappapietra, B., & Ravelli, A. (2016). Juvenile idiopathic arthritis: diagnosis and treatment. Rheumatology and therapy, 3(2), 187-207.
Hefti, F. (2015). Juvenile rheumatoid arthritis. In Pediatric Orthopedics in Practice (pp. 661-665). Springer, Berlin, Heidelberg.
Schempp, C. M., Schauer, F., Huhn, C. K., Venhoff, N., & Finzel, S. (2019). Skin inflammation associated with arthritis, synovitis and enthesitis. Part 2: rheumatoid arthritis, reactive arthritis, Reiter’s syndrome, Lyme borreliosis, dermatomyositis and lupus erythematosus. JDDG: Journal der Deutschen Dermatologischen Gesellschaft, 17(2), 167-181.
Rheumatoid arthritis affects an estimated 293,000 people, or one person in 100. Rheumatoid Arthritis causes inflammation in the lining of the joints or other internal organs. This inflammation separates Rheumatoid Arthritis from other more common forms of arthritis, like osteoarthritis. Rheumatoid Arthritis can affect people of all ages from little kids to old people. It most commonly appears between the ages of 25 and 50. Rheumatoid Arthritis affects women three times more often than men. It is a chronic disease, affecting many joints throughout the body, and resulting in damage to cartilage, bone, tendons and ligaments, not just joints like I thought. Although there is no cure or prevention for Rheumatoid Arthritis, there are ways to help relieve the pain and keep people active, happy, and productive.
Rheumatoid Arthritis may start gradually or with a sudden, severe attack with flu-like symptoms, pretty weird for a bone disease. Pain and swelling of the joints, usually symmetrical, is the first sign. Stiffness in the morning, of joints and muscles may also be a telltale sign of Rheumatoid Arthritis. Rheumatoid Arthritis brings general weakness and fatigue to the affected person. Fever and weight loss are the most severe and rare symptoms of Rheumatoid Arthritis. Rheumatoid Arthritis symptoms vary from person to person. In some people the disease will be mild with periods of activity or joint inflammation, called flare-ups, and inactivity, called remissions. In other cases the disease will be continuously active and appear to get worse over time.
Rheumatoid Arthritis causes the synovial lining of the joints to become inflamed. Researchers and doctors believe that the inflammation is triggered by the body’s immune system failing to recognize body tissue as normal, therefore attacking it and damaging the joint. The damage becomes worse because the immune system’s attack does not stop, and results in destruction of cartilage, bone, tendons and ligaments that can lead to permanent deformity and disability. Juvenile Rheumatoid Arthritis Essay
One important way to distinguish Rheumatoid Arthritis from other forms of arthritis is by the pattern of the joints being attacked. For example, Rheumatoid Arthritis affects the wrists and many of the hand joints but usually not the joints that are closest to the fingernails. Other joints commonly affected by Rheumatoid Arthritis include the elbows, shoulders, neck, jaw, feet, ankles, knees, and hips. Other than the neck, the spine usually is not directly affected by Rheumatoid Arthritis.
Along with the painful joints, Rheumatoid Arthritis can cause inflammation in other body tissues and organs. In 20% of cases, lumps called rheumatoid nodules develop under the skin, often over bones in certain areas. These occur most often around the elbow but can be found elsewhere on the body and even in internal organs. Occasionally, people with Rheumatoid Arthritis will develop inflammation of the membranes that surround the heart and lung or inflammation of the lung tissue itself. Inflammation of tear glands and salivary glands results in dry eyes and dry mouth. Rarely, Rheumatoid Arthritis causes inflammation of the blood vessels, which affects the skin, nerves and other organs. Juvenile Rheumatoid Arthritis EssayNo one knows for sure what causes Rheumatoid Arthritis, although scientists are well on their way to understanding the events that lead to unusual responses of the body’s immune system. Many researchers believe that Rheumatoid Arthritis might be triggered by an infection, but there is presently no proof to prove them right or to prove them wrong. It is possible that a germ that everyone is exposed causes the body’s immune system to react abnormally in people that have a defective gene or something.
Although there is no cure for Rheumatoid Arthritis today, a lot can be done to manage this disease. A variety of treatments exist to treat the symptoms resulting in less pain, stiffness and easier movement. Four major treatment approaches are recognized in the management of Rheumatoid Arthritis: medications, physical exercises, joint protection, and lifestyle changes, and surgical. However none of this will work unless the affected person give their 100% effort.
From all I have learned through this report, the most impacting fact is the pain that is suffered. I am glad that I am not cursed with this infliction. I truly pity those who have been cursed with Rheumatoid Arthritis and hope a cure is found so their ailing will be no longer a problem. We should all say a prayer for them.Juvenile Rheumatoid Arthritis Essay