Question

Case Study 5: Knees

Ann, who is 35 years old, complains of progressively worsening, fluctuating pain at her knees and the joints of her hands for several weeks. The pain is worse in the early morning. The symptoms are symmetrical – the same joints on both sides of her body are affected. She also reports a low-grade fever and fatigue at times. Physical examination reveals limited movement of her wrists and inflammation with spongy swelling around the knee joints. Slight ulnar deviation of the fingers at the painful metacapophalangeal joints of her hands is noted. There are no skin lesions present. Many different disorders can cause joint pain. Study the following information to make a preliminary diagnosis:

Synovial fluid analysis: cloudy, reduced viscosity, absence of bacteria, no uric acid crystals.

X-ray studies of the hand: detectable deterioration of articular cartilages in metacarpophalangeal joints.

Serum rheumatoid factor: 1:60 titer, elevated erythrocyte sedimentation rate.

1. What disorder is causing Ann’s joint pain? What information led to this diagnosis?

2. Could Ann’s diagnosis be Osteoarthritis? Why or why not?

3. Could Ann’s diagnosis be Gout? Why or why not?

4. Could Ann’s diagnosis be Systemic lupus erythromatosus? Why or why not?

4. Could Ann’s diagnosis be Systemic lupus erythromatosus? Why or why not?

Answer 1

1. The disorder affected the Ann's joint is rheumatoid arthritis. The RA factor is found to be elevated shows RA. The metacarpophalangeal joints are affected is a significant character of RA. The pain is more in the morning and fingers appears to be stiffened and fatigueness seen is the characteristics of RA.

2. It will not be osteoarthritis. The metacarpophalangeal joints are least affected by OA. Only by the pain in the knees we can't point out that it is OA. OA patients so not have elevated RA factor.

3. It will not be gout. For a gout patient we can see uric acid crystals in the synovial fluid. But Ann is free of that.

4. It cannot be SLE. Its an autoimmune disorder. By looking to the elevated ESR only we cannot determine that this is SLE. In SLE the immune system reacts to itself and fail. In such cases there will be a bacterial or other infection. So that's not seen in test.