A 27-year-old patient visits a rheumatology clinic for a follow-up on her stable systemic lupus erythematosus (SLE) treatment. She informs the doctor that she and her partner are planning to conceive within the next 6 months. Can you suggest which SLE medication would be safe for her to continue during pregnancy?
A 28-year-old woman of Afro-Caribbean descent visits her doctor with complaints of fatigue, widespread musculoskeletal pain, low mood, and swollen lumps in her neck and armpit. Her blood test results are as follows:
– Hemoglobin (Hb): 107g/L (Male: 135-180, Female: 115-160)
– Platelets: 140* 109/L (150-400)
– White blood cells (WBC): 3.2* 109/L (4.0-11.0)
– Sodium (Na+): 138 mmol/L (135-145)
– Potassium (K+): 4.0mmol/L (3.5-5.0)
– Urea: 12.5mmol/L (2.0-7.0)
– Creatinine: 165µmol/L (55-120)
– C-reactive protein (CRP): 115mg/L (<5)
– Antinuclear antibodies: Positive
– Anti-double-stranded DNA: Positive
As a result of her abnormal renal function results, a renal biopsy is conducted and examined under electron microscopy, revealing no mesangial deposits. Based on her likely diagnosis, what medication should be prescribed to this patient?
A 50-year-old woman has been referred to a rheumatologist by her GP due to complaints of fatigue and joint pain in her fingers. She has a history of mild asthma, which is managed with a salbutamol inhaler, and is known to have an allergy to co-trimoxazole. Her blood tests revealed a positive rheumatoid factor and an anti-CCP antibody level of 150u/ml (normal range < 20u/ml). Which medication could potentially trigger an allergic reaction in this patient?
A 28-year-old man presents to the Emergency Department with severe right lower quadrant pain and 7 episodes of diarrhoea in the last 24 hours. His observations are blood pressure 100/75 mmHg, heart rate 85 bpm, respiratory rate 15 breaths per minute, temperature 38.0ºC. He has a past medical history of Crohn’s disease and is allergic to aspirin. Which medication should be avoided in the management of this patient?
A 55 year old woman comes to the clinic with symptoms and signs that indicate rheumatoid arthritis. She has been experiencing bilateral swelling of her metacarpophalangeal joints, early morning stiffness lasting for about an hour, and a raised nodule on the extensor surface of her left forearm for the past 2 months. Her rheumatoid factor test came back positive. What is the recommended initial treatment for her arthritis?
Ms. Johnson, a 25-year-old woman, visits her doctor complaining of abdominal pain and changes in her bowel movements. She has been experiencing loose stools with occasional blood. She also experiences lower abdominal cramps and urgency. She denies having joint pain but has previously had a red eye. Her mother has a history of rheumatoid arthritis.
After undergoing a rheumatological screening, Ms. Johnson’s results show a positive pANCA. No other antibodies were found to be above normal levels. What is the most likely condition responsible for this positive result?
A nine-year-old girl arrives at the emergency department with her mother after falling on her outstretched left hand during recess. She is experiencing pain and swelling around her left elbow and forearm.
Upon examination:
Heart rate: 92/minute. Respiratory rate: 20/minute. Blood pressure: 102/70 mmHg. Oxygen saturations: 99%. Temperature: 37.5 ºC. Capillary refill time: 2 seconds.
Left arm: the elbow is swollen and red. The skin is intact. The joint is tender to the touch and has limited range of motion. Sensation is normal. Pulses are present.
Right arm: normal.
X-rays of the patient’s left elbow and forearm reveal a proximal fracture of the ulna with a dislocation of the proximal radial head.
What is the term used to describe this injury pattern?
Which of the following features is least characteristic of polymyalgia rheumatica in patients?
A 75-year-old male is admitted to the acute medical ward with a deep ulcer over the inferior aspect of his heel which reaches the bone. He had not noticed it and seems unconcerned. His son, who brought him into hospital, says that he has poor sensation in his feet and rarely takes off his socks and shoes. His past medical history includes type 2 diabetes, for which he is on a biphasic insulin regimen.
His temperature is 37.9ºC, and his heart rate is 101/min.
What is the most effective way to confirm the probable diagnosis?
A 67-year-old man presents with weakness of the thighs and shoulders leading to difficulty climbing stairs and lifting objects. He has also noticed a purple-coloured rash, most pronounced on his face and affecting the eyelids. On examination, he has itchy and painful papules over the metacarpophalangeal (MCP) joints. He is subsequently diagnosed with dermatomyositis.
What investigations will be included in the next steps of his management?