MRCP2-2031

MRCP2-2031

A 47-year-old man presents to the gastroenterology clinic with a 7 month history of abdominal pain, diarrhea, and weight loss. His symptoms have been progressively worsening over the past few weeks and he has also been experiencing joint pain in his hands and feet. The abdominal pain is not relieved by defecation and is associated with bloating. He reports a weight loss of approximately 10 kg over the past 7 months.

The patient works in the IT industry and frequently travels to Southeast Asia. He is married and does not smoke. On examination, he has soft and non-tender lymph nodes in the cervical and inguinal regions. His wedding ring is loose and loss of the nail angle is noted. There is mild tenderness in the epigastric region, but no organomegaly or evidence of swelling, erythema, or synovitis in the hands or feet. His pulse, blood pressure, and temperature are normal.

Laboratory results show a hemoglobin level of 10.4 g/dl, platelets of 222 * 109/l, WBC of 6.96 * 109/l, Na+ of 139 mmol/l, K+ of 3.6 mmol/l, urea of 5.1 mmol/l, creatinine of 78 µmol/l, bilirubin of 14 µmol/l, ALP of 120 u/l, ALT of 34 u/l, γGT of 55 u/l, and albumin of 26 g/l.

What is the most appropriate treatment for this patient?