12-02-2015, 08:45 AM
A 68-year-old woman comes to the office because of progressive weakness and numbness in her arms and spasticity in her legs for the past 3 weeks. She also has neck pain and diffuse arthralgias in the extremities. She has a 20-year history of rheumatoid arthritis, for which she takes etanercept and celecoxib. The patient is 157 cm (5 ft 2 in) tall and weighs 44 kg (96 lb), BMI is 18 kg/m2. Vital signs are temperature 37.0°C (98.6°F), pulse 72/min, respirations 14/min, and blood pressure 114/72 mm Hg. Muscle strength is 3/5 in the upper extremities and 4/5 in the lower extremities. Deep tendon reflexes are 3+ in all extremities. Babinski sign is present bilaterally. Sensation to vibration is severely decreased in the lower extremities. Which of the following is the most likely cause of this patient's worsening condition?
A) Angiopathic neuropathy related to rheumatoid arthritis B) Atlantoaxial subluxation C) Neuropathy caused by medications
D) Polymyositis E) Vasculitis of the central nervous system
A) Angiopathic neuropathy related to rheumatoid arthritis B) Atlantoaxial subluxation C) Neuropathy caused by medications
D) Polymyositis E) Vasculitis of the central nervous system