The purpose of conducting a blood test to test for Rheumatoid arthritis (RA) is to find out if there is any inflammatory process in the body. A person who has Rheumatoid arthritis develops an increased sed rate, and their erythrocyte sedimentation rate rises too. The C-reactive protein also elevates and creates inflammations in the body. The blood test could also detect a rheumatoid factor and anti-CCP antibodies. The anti-CCP auto-antibody is present in about 60-80% of the people with Rheumatoid arthritis, and the test is more accurate. The antinuclear antibody test will look for the compounds that have the potential to attack a cell's nucleus and cause damage. The uric acid test detects the presence of uric acid crystals and inflammation in and around the joints that could indicate that the patient has Rheumatoid arthritis (Aletaha & Smolen, 2018). The C reactive protein (CRP) blood test determines the level of CRP. A person with CRP levels of over 3.0mg/L is likely to have an inflammatory disease like Rheumatoid arthritis. The rheumatoid factor blood test is necessary to detect the presence of the rheumatoid antibody in the blood.
High uric acid levels in the blood could be an indication of gout. Average uric acid values for men are 4.0-8.5mg/DL, while for women, they range between 2.5 and 7.5mg/DL. The Antinuclear Antibodies test is done to detect the presence of any antinuclear antibodies that could be an indication of gout. High C reactive proteins could be an indication of gout. The rheumatoid test determines the uric acid levels. High uric acid levels in the blood could be an indication of gout.
X-ray imaging will assist in ruling out other conditions that could be having similar symptoms to those of gout. X-ray shows if there are any soft tissue masses around the joints which are created by the deposition of urate crystals. The presence of crystals will indicate that Ms. A.J is positive for gout.
Plantar Fasciitis does not appear on X-ray, but it is necessary to perform the test to detect the presence of fractures that may be causing the pain. If the pain is not at the bottom of the foot, there will be no possibility of Plantar Fasciitis.
MRI examines soft tissue and bone erosions to determine the presence of gout. The MRI test measures the synovial volume and inflammation characteristic of RA if there will be well-demarcated nodular thickenings.
Joint Fluid Test
The joint fluid test detects for the presence of urate crystals in the patient's body fluid, which is a possible indication of gout. If urate crystals appear, Ms. A.J will test positive for gout.
The joint fluid test shows the accumulation of synovial fluid in the synovium, thus causing inflammation and swelling. If there will not be any accumulation of synovial fluid, the test will be negative for RA.
Rheumatoid Arthritis: The condition affects joints and other areas, and it occurs when the immune system attacks a person's body tissues mistakenly (Aletaha & Smolen, 2018). The illness damages other body parts like the skin, blood vessels, heart, and lungs (Aletaha & Smolen, 2018). RA is characterized by painful swelling in the lining of the joints. The primary symptoms are swollen and stiff joints, fatigue, fever, and loss of appetite. Ms. AJ has difficulty in movement, she cannot walk without support, and she complains about pain in her joints. Therefore, there is a possibility of swelling in her joints.
Plantar Fasciitis: The condition is a heel pain where there are tissues inflammatory across the bottom of the foot (Petraglia, Ramazzina, & Costantino, 2017). The pain is more intense in the morning, but it decreases as one makes some steps. The condition is caused by continuous stretching and tearing of the bowstring found at the arch of the foot (Petraglia et al., 2017). In this case, the possibility of Ms. A.J having Plantar fasciitis will be eliminated since she experiences pain on other body parts apart from the heel.
Gout: The condition is one of the types of arthritis the occurs when there is excessive accumulation of uric acid in the blood. The uric acid crystals accumulate in the joints (Qaseem, McLean, Starkey, & Forciea, 2017). Inflammations and pain on the joints, especially on the big toe, are the primary symptoms of the condition.
- Recommended erythrocyte sedimentation rate test to measure her level of inflammations.
- Recommended physical therapy for exercises to reduce stiffness of the joints and keep them flexible.
- Recommended antibiotics to help reduce the pain in her joints by reducing inflammations.
- Prednisone 10mg to be taken orally every day.
- Betamethasone 5mg tablets to be taken every day.
- Ibuprofen 600mg every six hours.
- Recommended the patient not to sit or sleep for a long time. Ms. A.J should walk around short distances with someone by her side to guide her.
- Recommended that Ms. A.J should keep warm at all times, especially when stepping on the floor.
Gave Ms. A.J a pamphlet explaining the diet she should consume. There should be lots of fruits, vegetables, and whole grains in her diet. The patient should void consuming processed foods and lean meats for the sake of her health.
Health Maintenance and Prevention:
Ms. A.J. only relies on public transport, which requires her to walk from her home to the road. Due to the pain in her joints, sometimes she is unable to get to the health center to get her prescriptions. Missing her dosage may cause harm to her health, and her problem might escalate. Therefore, alternative methods of care must be considered.
What I wish could be done for Ms. A.J. is to have home health care where her physician and therapist can see her and bring the drugs to her. The provision of home care will enable the patient to relax, rest, exercise, and not struggle to travel to the hospital.
Aletaha, D., & Smolen, J. S. (2018). Diagnosis and management of rheumatoid arthritis: a review. Jama, 320(13), 1360-1372. Retrieved from https://jamanetwork.com/journals/jamaoncology/fullarticle/2705192
Petraglia, F., Ramazzina, I., & Costantino, C. (2017). Plantar fasciitis in athletes: diagnostic and treatment strategies. A systematic review. Muscles, ligaments and tendons journal, 7(1), 107. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5505577/
Qaseem, A., McLean, R. M., Starkey, M., & Forciea, M. A. (2017). Diagnosis of acute gout: a clinical practice guideline from the American College of Physicians. Annals of internal medicine, 166(1), 52-57. Retrieved from https://annals.org/aim/fullarticle/2578527/diagnosis-acute-gout-clinical-practice-guideline-from-american-college-physicians?searchresult=1
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