Rheumatoid Arthritis (RA) Assignment
Rheumatoid Arthritis (RA) Assignment
Instructions: The Assignment (1- to 2-page case study analysis) Develop a 1- to 2-page case study analysis in which you: • Explain why you think the patient presented the symptoms described. • Identify the genes that may be associated with the development of the disease. • Explain the process of immunosuppression and the effect it has on body systems. By Day 7 of Week 2 Submit your Case Study Analysis Assignment by Day 7 of Week 2. Reminder: The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The sample paper provided at the Walden Writing Center provides an example of those required elements (available at https://academicguides.waldenu.edu/writingcenter/templates). All papers submitted must use this formatting. Case study: A 49-year-old patient with rheumatoid arthritis comes into the clinic with a chief complaint of a fever. Rheumatoid Arthritis (RA) Assignment
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Patient’s current medications include atorvastatin 40 mg at night, methotrexate 10 mg po every Friday morning and prednisone 5 mg po qam. He states that he has had a fever up to 101 degrees F for about a week and admits to chills and sweats. He says he has had more fatigue than usual and reports some chest pain associated with coughing. He admits to having occasional episodes of hemoptysis. He works as a grain inspector at a large farm cooperative. After extensive work-up, the patient was diagnosed with Invasive aspergillosis.
Invasive Aspergillosis in a 49 Year-Old Patient with Rheumatoid Arthritis on Methotrexate and Corticosteroids
Rheumatoid arthritis (RA) is an autoimmune disease that occurs as a result of the body’s immune system attacking its own cells. Treatment is by medications that suppress the immune response. In the case of this patient these are methotrexate and the corticosteroid prednisone (Mayo Clinic, 2019; Challa, 2018; Bello et al., 2017). Invasive aspergillosis (IA) on the other hand occurs only in persons whose immunity has been compromised, such as those on medications for RA (Challa, 2018). This patient presents with fatigue because it is a symptom of RA. Fever and chills show that there is an active infection (IA) that the body is attempting to fight. Chest pain, coughing, and hemoptysis are symptoms indicative of the fact that this patient with IA has fulminant pulmonary aspergillosis that is destroying respiratory alveolar units and blood vessels.
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In this patient, IA has developed as a result of a genetic defect that allows the development of RA which is treated by immunosuppressant medications (methotrexate and prednisone). It can then safely be said that the invasive aspergillosis has been indirectly caused by this genetic defect. The genes associated with the development of rheumatoid arthritis are known as human leukocyte antigen (HLA) genes, particularly the one referred to as HLA-DRB1 (U.S. National Library of Medicine, 2020). Rheumatoid Arthritis (RA) Assignment
The process of immunosuppression is conferred by the mechanism of action of the medications that are used to manage the rheumatoid arthritis. Methotrexate and prednisone interfere with the secretion of cytokines and T-cell activity. They also inhibit inflammation with the result that the host’s defences are compromised. Any normal or symbiotic microbes that are usually not pathogenic and other usually harmless environmental microbes can then cause serious disease in the host. This is how the usually contained mould Aspergillus fumigatus manages to cause invasive aspergillosis (Challa, 2018).
References
Bello, A.E., Perkins, E.L., Jay, R., & Efthimiou, P. (2017). Recommendations for optimizing methotrexate treatment for patients with rheumatoid arthritis. Rheumatology: Research and Reviews 2017:9 67–79. Doi: 10.2147/OARRR.S131668
Challa, S. (2018). Pathogenesis and pathology of invasive aspergillosis. Current Fungal Infection Reports, 12, 23-32. Doi: https://doi.org/10.1007/s12281-018-0310-4
Mayo Clinic (March 1, 2019). Rheumatoid arthritis. Retrieved 14 June 2020 from https://www.mayoclinic.org/diseases-conditions/rheumatoid-arthritis/symptoms-causes/syc-20353648
U.S. National Library of Medicine (2020). Rheumatoid arthritis: Causes. Retrieved 14 June 2020 from https://ghr.nlm.nih.gov/condition/rheumatoid-arthritis#genes
Rheumatoid Arthritis (RA) Assignment
