NIT THREE Clinical Problems SP 18.docx[Compatibility Mode]-Word rences Mailings
ID: 3512210 • Letter: N
Question
NIT THREE Clinical Problems SP 18.docx[Compatibility Mode]-Word rences Mailings Review View Tell me what you want to do ·A- -1.lca .H.LNormal!!No Spac-. Heading 1 Heading 2 Title Paragraph Styles References: Porths Pathophysiology pages 1461-1463 Case Two: 15 points A 30-year old woman, recently diagnosed with rheumatoid arthritis (RA), complains of general fatigue and weight loss along with symmetric joint swelling, stiffness and pairn The stiffness is more prominent in the morning and subsides during the day with activity. Her blood labs reveal a rheumatoid factor (RF) of 120 lU/mL (values of 0-39 IU/mL considered non-reactive; 40-79 IU/mL are weakly reactive; and >80 lU/mL are considered reactive) and a positive anti-CCP antibody test. A. Describe the etiology and pathophysiology (i.e, the mechanism of normal I physiology disruption) of the joint damage that occurs with RA. B. What does RF stand for and explain what it does in the body? C. What is the meaning of her RF lab results? D. What is the significance of this woman's positive anti-CCP test results?Explanation / Answer
1. A. Etiology....The cause of RA is unknown. Genetic, environmental, hormonal, immunologic, and infectious factors may play significant roles. Socioeconomic, psychological, and lifestyle factors (eg, tobacco use, the main environmental risk [9] ) may influence disease development and outcome
B. Pathophysiology...
understood. An external trigger (eg, cigarette smoking, infection, or trauma) that sets off an autoimmune reaction, leading to synovial hypertrophy and chronic joint inflammation along with the potential for extra-articular manifestations, is theorized to occur in genetically susceptible individuals.
Synovial cell hyperplasia and endothelial cell activation are early events in the pathologic process that progresses to uncontrolled inflammation and consequent cartilage and bone destruction. Genetic factors and immune system abnormalities contribute to disease propagation.
CD4 T cells, mononuclear phagocytes, fibroblasts, osteoclasts, and neutrophils play major cellular roles in the pathophysiology of RA, whereas B cells produce autoantibodies (ie, rheumatoid factors). Abnormal production of numerous cytokines, chemokines, and other inflammatory mediators has been demonstrated in patients with RA, including the following:
Tumor necrosis factor alpha (TNF-)
Interleukin (IL)-1
IL-6
IL-8
Transforming growth factor beta (TGF-ß)
Fibroblast growth factor (FGF)
Platelet-derived growth factor (PDGF)
Ultimately, inflammation and exuberant proliferation of the synovium (ie, pannus) leads to destruction of various tissues, including cartilage (see the image below), bone, tendons, ligaments, and blood vessels. Although the articular structures are the primary sites involved by RA, other tissues are also affected.
2. Rheumatoid factor.
A rheumatoid factor test measures the amount of rheumatoid factor in your blood. Rheumatoid factors are proteins produced by your immune system that can attack healthy tissue in your body.
High levels of rheumatoid factor in the blood are most often associated with autoimmune diseases, such as rheumatoid arthritis and Sjogren's syndrome. But rheumatoid factor may be detected in some healthy people, and people with autoimmune diseases sometimes have normal levels of rheumatoid factor.
3 .rheumatoid factor lab results.
A positive rheumatoid factor test result indicates that a high level of rheumatoid factor was detected in your blood. A higher level of rheumatoid factor in your blood is closely associated with autoimmune disease, particularly rheumatoid arthritis. But a number of other diseases and conditions can raise rheumatoid factor levels, including:
Some healthy people — particularly older individuals — have positive rheumatoid factor tests, though it's not clear why. And some people who have rheumatoid arthritis will have low levels of rheumatoid factor in their blood.
4.
A positive anti-CCP test result can be used in conjunction with other blood tests, imaging tests, and physical examinations to reach a rheumatoid arthritis diagnosis.
A patient with rheumatoid arthritis who tests positive for anti-CCP in their blood has what’s known as seropositive rheumatoid arthritis. This is as opposed to someone who has been diagnosed with rheumatoid arthritis but tests negative for anti-CCP antibodies and/or rheumatoid factor.
Related Questions
Navigate
Integrity-first tutoring: explanations and feedback only — we do not complete graded work. Learn more.