Rheumatoid arthritis

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Rheumatoid arthritis

Post  Mohammad Tayeb on Wed Jan 02, 2008 4:03 am

45 years old woman with long standing history of RA presents with a 6 month history of increasing dypnea. She does not experience orthopnea. The venous pressure is not elevated & her heart sounds are normal. Her ECG is normal. Blood gases on air show an arterial PO2 7.7 kPa, venous PaCo2 is 4.9 kPa, PH 7.45. NOW:

1- What is the probable Dx?

2- What are other physical signs that u look for?

3- What are other helpful investigations that u send him? What result u expect?

Mohammad Tayeb

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Re: Rheumatoid arthritis

Post  Ahmed Al-Kaisy on Wed Jan 02, 2008 2:12 pm

hi dear, first i would like to thank u for this beautiful case...

the first thing came into my mind is pleural effusion due to rhmeumatoid arthritis...

we should look for the usual physical signs of pleural effusion as decreased chest expansion, decrease vocal fremitus..............etc..

we aspirate pleural fluid for analysis...we expect to exudative pleural effusion...
the pleural fluid is exudative if one or more of the following criteria are present:(davidson, page 665, new edition)

1- pleural fluid protein:serum protein ratio more than 0.5
2- pleural fluid LDH:serum LDH ratio more than 0.6
3- pleural fluid LDH more than two thirds of the upper limit of normal serum LDH.

also there is cholestrol in chronic effusion, very low glucose in pleural fluid...

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Re: Rheumatoid arthritis

Post  Nader on Sat Sep 27, 2008 7:36 am

I completly disagree with Dr Ahmed Al-Kaisy,because 6 months seems to long peroid to suffer from plurisy (THAT CAUSE PLUEARL EFFUSION) without chest pain and it is easy to dx it with good clnical exam,although here no data suggest EFFUSION

i will say this long standing RA and the problem now is complication of the medication of RA like MTX such as Acute interstitial pneumonitis which may occur in 1-5% of patients treated with methotrexate

Methotrexate-associated lung disease in rheumatoid arthritis
Methotrexate pneumonitis is an unpredictable and life-threatening side effect of methotrexate therapy.
Presentation is often subacute with symptoms often present for several weeks or months before diagnosis.
Presents most often with cough, dyspnoea and fever. May progress rapidly to respiratory failure.
Early diagnosis, cessation of methotrexate, and treatment with corticosteroids and/or cyclophosphamide are important in management.
There is a high rate of recurrence of lung injury after re-challenge with methotrexate.

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Post  mahmood on Fri Feb 27, 2009 9:02 am

where is the answer?

Live as if you were to die tomorrow. Learn as if you were to live forever

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Re: Rheumatoid arthritis

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