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A 36-year-old woman comes to your office claiming that she has been feeling generalized weakness, along with stiff hands, wrists, and knees upon awakening, which lasts about 2 hours. She has also had a 4-pound weight loss over the last 2 1/2 weeks and an itchy rash on her chest. She claims the symptoms began only 2 to 3 weeks ago, and they have been debilitating. The stiffness and pain are bilateral and symmetrical. The symptoms have caused her to be late to work and have interfered with her duties. She appears tired. Her vital signs are normal. There is a maculopapular, fine rash on her anterior chest wall, which is not restricted to the skin fold areas. There are no nodules. The lungs, heart, and abdomen are normal. Her extremities are not edematous, but there is tenderness upon palpation of wrists and knees but no effusions or joint deformity. There is no tenderness over the tendon sheaths. Laboratory studies show: white cell count 8,600/mm3, hematocrit 39.4%, platelets 215,000/mm3, BUN 8 mg/dL, creatinine 0.9 mg/dL, glucose 125 mg/dL, and calcium 8.6 mEq/L. The rheumatoid factor and ANA are negative. X-rays of the joints are normal. Which of the following is the most appropriate action?
(A) Anti-double-stranded DNA
(B) Ceftriaxone and doxycycline
© Methotrexate
(D) Intravenous immunoglobulin G (IgG)
(E) Serum Parvovirus B19 IgM
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But,the lacy rash and joint involvement are typical of Parvo,right.And,she is an adult ,so,slapped cheek might not be there
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So,E ryt?
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yes zephyr is right.
This woman most likely had an acute infection with Parvovirus B19, which can cause a syndrome that mimics rheumatoid arthritis. Arthralgias from Parvovirus B19 most commonly occur in woman in their thirties, whereas rheumatoid arthritis occurs more commonly in older individuals. Parvovirus B19 gives a polyarthritis that affects the proximal interphalangeal joints of the hands, wrists, and knees. Arthralgias are common. The diagnosis is mostly clinical when one gets a lacy, maculopapular, truncal rash, along with malaise and a headache with little fever. There is a laboratory test for serum IgM and IgG for Parvovirus B19. Treatment is symptomatic, and most of these symptoms will resolve on their own.
Methotrexate is an incorrect choice because the patient's symptoms are too new to be considered rheumatoid arthritis, which is usually at least 6 weeks in duration and would be associated with a positive test for a rheumatoid factor in 75% of patients. The ANA is also weakly and nonspecifically positive in rheumatoid arthritis. Treatment for rheumatoid arthritis involves NSAIDs accompanied with disease-modifying drugs, such as hydroxychloroquine or sulfasalazine. There may be a need for using three agents in very severe disease. Some of the other drugs that could be used are methotrexate, cyclosporine, and steroids.
Intravenous immunoglobulins are used to treat aplastic crisis from parvovirus. This patient's hematocrit is normal. The arthralgias of parvovirus should resolve without specific therapy, and NSAIDs are only used for symptomatic relief. Ceftriaxone and doxycycline would be used for gonococcal or chlamydial arthritis. In that case, one would expect fever, migratory arthritis, a petechial rash, and tenosynovitis. Testing for anti-double stranded DNA would be appropriate for evaluating a patient for lupus
phyr is right.
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E....very goog explantion sara
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