Rheumatoid Arthritis Case Study Paper

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1 Rheumatoid arthritis 2 Pulmonary fibrosis - UIP pattern 3 Osteoporosis 4 Restless legs symptoms 5 Depression 6 Gastro-oesophageal disease/hiatus hernia Thank your referring Caterina Gallo, an 80-year-old lady of Italian origin who immigrated to Australia 63 years ago. Caterina is a lifelong non-smoker, although reports some passive smoke exposure. She has previously worked in a clothing factory as a machinist and in a deli. She reports no significant occupational dust exposure. She keeps no pets. Caterina reports being diagnosed with rheumatoid arthritis some three or four years ago and I note is under the care of A/Prof Russell Buchanan. She has been taking methotrexate for at least a couple of years and prednisolone at a current…show more content…
There was clubbing evident peripherally and chest auscultation was notable for diffuse fine lower to mid zone crackles. Two heart sounds were audible with a slightly prominent second heart sound, but there were no signs of heart failure. Assessment: Caterina has clear evidence of pulmonary fibrosis with a usual interstitial pneumonia pattern. This is a pattern that is seen with idiopathic pulmonary fibrosis, but in Caterina’s case, one would presume that it is either due to the rheumatoid arthritis or the methotrexate. I sense that Caterina has had this problem prior to initiating methotrexate and the fact that her lung function tests have been stable over the last few years indicates a non-progressive disease. I have asked her to check at home whehter she has any old imaging for me to review, but otherwise I have suggested we obtain updated lung function tests and chest imaging in a couple of months once any residual impairment from the recent infection has cleared. I will need to then to have discussion with Russell Buchanan as to whether Caterina should continue with methotrexate or whether we consider an alternative regimen such as micophenolate combined with prednisolone. I will see Caterina again in a couple of

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