Hi everyone. My name’s Abby, and we’re going to go through a case study about rheumatoid arthritis together. Let’s get started. In this scenario, a new graduate nurse, Tim, is shadowing at a local primary care clinic as part of his residency program. The first appointment of the day is a 38 year old female patient named Doris. She’s been complaining of pain in her joints, in her arms and legs, as well as stiffness in the morning. She reports these symptoms have been going on a while and worsening to the point that now she’s seeking medical treatment. The supervising nurse of Tim says, “I wonder, is it rheumatoid arthritis?” Now that we have this information, let’s take a look at critical thinking check numbers one, two, and three below.

Great job! While going through her health history, the patient states that she has a relative with joint problems, but thought her own pain is attributed to stress. She has a full-time job with many deadlines and two children. She denies alcohol or substance abuse, but says I still smoke about a half a pack a day. Her primary concern is that her hands don’t seem to work right. She denies rashes or skin problems, and also says, “I’m never sick, especially lately. I’ve been healthy as a horse. This is such a hassle.” Now that we have these results, let’s take a look at critical thinking check number four below.

Excellent. The provider completes his exam and takes a detailed history. He advises nursing staff to prepare, to take labs and schedule a follow up appointment for her to get the results. Tim asks about radiologic exams, like x-rays. The provider states those aren’t needed right now. With all of this in mind, let’s take a look at critical thinking checks number five and number six below.

Great job. In two weeks, Doris returns for her lab results. Let’s take a look. Her first lab was the ESR. This is a lab that indicates whether or not there’s inflammation in the body. Her result was 69. Her CRP lab also stands for c-reactive protein, a protein made in the live was 15r. That also helps us know if there’s inflammation in the body. Her ANA lab, the anti-nuclear antibody test was positive. That’s a test that looks for autoimmune disorders. The rheumatoid factor test was also positive. This is when proteins that are produced by the immune system can actually attack healthy tissue again, showing an auto-immune disorder. Her hemoglobin was 10 g/dL, her hematocrit 30% and her white blood cell count was within normal limits. Her platelets were also right at 500. Now that we have this information, let’s take a look at critical thinking check number seven below.

Well done. The provider refers Doris to a rheumatologist. He educates the patient about how it is vital that she follow up as soon as possible. After the provider leaves, she asks, “What’s the rush? Am I going to die or something?” Hopefully not. Now, let’s take a look at critical thinking check number eight below.

Excellent. Doris verbalizes, understanding of the need to see a specialist. She says she has read a little on the internet about rheumatoid arthritis and wonders about medications that she may be prescribed. Now let’s take a look at critical thinking check number nine below.

Nicely done. Doris has made an appointment with a rheumatologist and Thanks the staff for their help. Now, let’s take a look at critical thinking check number 10.

Great job guys. This wraps up the study on rheumatoid arthritis. Please take a look at the attached study tools and test your knowledge with a practice quiz. We love you guys. Now go out and be your best self today, and as always, happy nursing!

References:

Diagnosis and differential diagnosis of rheumatoid arthritis
Authors:PJW Venables, MA, MB BChir, MD, FRCPJoshua F Baker, MD, MSCE updated Oct, 2021; Patient education: Rheumatoid arthritis treatment (Beyond the Basics)
Author:PJW Venables, MA, MB BChir, MD, FRCP updated Feb, 2020; Clinical manifestations of rheumatoid arthritis
Authors:PJW Venables, MA, MB BChir, MD, FRCPBryant R England, MD, PhD updated Apr, 2021