Pathophysiology Case Study: Patient Diagnosis and Treatment Plan

This assignment presents a comprehensive analysis of a pathophysiology case study. The student examines patient history, including symptoms like night sweats, chest pain, and smoking habits, along with environmental exposures. Detailed lab findings, including a complete blood count (CBC), chemistry panel, and immunology results (ESR, CRP, VDRL, ANA), are meticulously reviewed. Based on these findings, the student proposes possible ailments, primarily focusing on Rheumatoid Arthritis (RA) due to positive ANA and inflammatory markers, while also considering Syphilis and Anemia. The assignment outlines a plan for follow-up tests, including ESR, CRP, Rheumatoid factor tests, and imaging studies. Furthermore, the pathophysiology of RA, including joint destruction and synovitis, is explained, along with treatment approaches using NSAIDs, immunosuppressants, and steroids. Finally, the student details the crucial aspects of a follow-up appointment, emphasizing the importance of monitoring patient well-being and treatment efficacy. This assignment is a thorough exploration of diagnostic reasoning and patient management in a healthcare context.

Running head: PATHOPHYSIOLOGY 1
PATHOPHYSIOLOGY
Student’s Name
University Affiliation
Course
Date

Running head: PATHOPHYSIOLOGY 2
SECTION 1
1. Have you ever been tested for HIV? If yes, when did you test?
2. Have you ever experienced night sweats, chills, chest and lower back pain? If yes, for
how long have you experienced this?
3. How long have you ever been hospitalized following any chronic illness?
4. Do you smoke? If yes, since when have you been smoking?
5. What are some of the environmental exposures in your place of work?
SECTION 2
Part 2: Findings
Complete Blood Count (CBC): Low compared to the reference range for women.
WBC count 3.8 x 109/L 4.8–10.8 x 109/L
RBC count 3.2 x 1012/L 4.0–5.0 x 1012/L
Hemoglobin 10.6 g/dl 12.0–16.0 g/dl
Hematocrit 32.8% 36–46%
Platelet count 140 x 109/L 150–450 x 109/L
ESR (Sedimentation Rate) was high at 61mm/hr (Reference range for women
-0-20mm/hr). Chem Panel Findings-High glucose at 101mg/dl against a reference range of 70-
99mg/dl and high iron at 189ug/dl against a reference range of 30-150ug/dl in women.
Immunology: C - reactive protein was high at 5.8mg/L against a normal range of 3-5mg/L,
Positive Venereal Disease Research Laboratory test (VDRL) and a positive Antinuclear
Antibodies (ANA) test with a ratio of 1:640.

Running head: PATHOPHYSIOLOGY 3
SECTION 3: POSSIBLE AILMENTS
Autoimmune diseases such as Rheumatoid Arthritis (RA) because of the positive
Antinuclear Antibodies (ANA) test which shows presence of antibodies which fight body tissues.
RA is associated with fever, fatigue, painful joints, soreness, rash and feeling of tiredness. Based
on the review of systems, the patient has a high temperature of 101F, complaints of fatigue,
painful joints, neck rash and cold sores. The C-reactive protein of 5.8mg/L indicates
inflammation which is present in RA. High ESR is also present in RA (Singh et al, 2012).
Syphilis could be another possible diagnosis for this patient due to the Positive Venereal
Disease Research Laboratory (VDRL) test. Signs and symptoms of syphilis include painless skin
rashes, fatigue, fever, weight loss and swollen lymph nodes. With reference to the case scenario,
the patient presented with these complaints (Fuchs et al, 2016).
The third possible diagnosis for this patient is anemia. This is because it associated with
low hemoglobin, low RBC count and low hematocrit. Signs of symptoms of anemia include
reduced exercise tolerance, shortness of breath, fatigue, lightheadedness and weakness. Based on
observations and patient history, he following manifestations are noted (Schett & Gravallese,2
012)
SECTION 4: PLAN AND FOLLOW UP TESTS/STUDIES
As per me, the most likely diagnosis is Rheumatoid Arthritis (RA). The tests I will use
for follow up are ESR to monitor inflammation process and rheumatoid disease, C-reactive
protein (CRP) test to monitor inflammation associated with RA, Rheumatoid factor test, Anti-
cyclic citrullinated peptide (anti-CPP) antibodies. I can also do imaging studies such as X-ray
and Magnetic Imaging Resonance (MRI) to check the severity of the condition (Schett &
Gravallese, 2012)

Running head: PATHOPHYSIOLOGY 4
SECTION 5: PATHOPHYSIOLOGY OF RHUEMATOID ARTHRITIS
It is a systemic inflammatory condition characterized by destruction of joints and
synovitis. Cytokines perpetuate synovial inflammation which persists leading to joint destruction
(Singh et al, 2012).Consequently, this leads to joint swelling, fever, painful joints, tiredness and
fatigue. RA is treated using Non-steroidal Anti-inflammatory drugs which relieve fever, joint
pain and inflammation, immunosuppressants are also to reduce immune responses and steroids
which modify hormones hence reducing inflammation (Choy, 2012).
SECTION 6: FOLLOW UP
In a follow up appoint with the patient, I would ask about various things which include
feelings of tiredness and fatigue, joint pain, joint swelling and fever. Asking about these factors
will be useful in determining the efficiency of the pharmacological management implemented on
the patient and find out signs of deterioration in order to implement alternative techniques.

Running head: PATHOPHYSIOLOGY 5
References
Choy, E. (2012). Understanding the dynamics: pathways involved in the pathogenesis of
rheumatoid arthritis. Rheumatology, 51(suppl_5), v3-v11.
Fuchs, F., Michaux, K., Rousseau, C., Ovetchkine, P., & Audibert, F. (2016). Syphilis infection:
an uncommon etiology of infectious nonimmune fetal hydrops with anemia. Fetal
diagnosis and therapy, 39(1), 74-77.
Schett, G., & Gravallese, E. (2012). Bone erosion in rheumatoid arthritis: mechanisms, diagnosis
and treatment. Nature Reviews Rheumatology, 8(11), 656.
Singh, J. A., Furst, D. E., Bharat, A., Curtis, J. R., Kavanaugh, A. F., Kremer, J. M., ... &
Bridges, S. L. (2012). 2012 Update of the 2008 American College of Rheumatology
recommendations for the use of disease‐modifying antirheumatic drugs and biologic
agents in the treatment of rheumatoid arthritis. Arthritis care & research, 64(5), 625-639.

Running head: PATHOPHYSIOLOGY 6