Case study: R is a 55-year-old white female who is being seen today for her annual physical. She states the following: "this getting old is tough.

Case study: R is a 55-year-old white female who is being seen today for her annual physical. She states the following: "this getting old is tough. I stay tired all the time, I hurt all over, and I am not as strong as I once was; plus, my feet are getting bigger and I can't wear any of my shoes." Upon further questioning, S reveals that her wrists have really been hurting, and she is afraid she may have carpal tunnel. Her family history is significant for a mother who died at 60 years of age with heart disease and some type of joint problem. The only significant past medical history that S reports is a "horrific case of the flu" about a year ago. 

1. What additional information would be helpful?

Upon further questioning, it is determined that her symptoms began about 3 months after her case of the flu. She is not taking any medications except an occasional ibuprofen that seems to help the pain in her wrist. She is a seamstress who works out of her home, and she sews for fun. She really does not know much about her mother's joint problems except that her hands were really stiff and bent.

Anemia, thyroid disease, and fibromyalgia were ruled out, and the tentative diagnosis is rheumatoid arthritis (RA).

2. How will the diagnosis of RA be confirmed?

3. What is the pathophysiology associated with RA?

4. What are some typical manifestations associated with RA?

A diagnosis of RA was confirmed, and S was started on nonsteroidal anti-inflammatory drugs.

5. What were some of S's risk factors for RA?