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Case 34 

Case 34
Chapter:
Case 34
Author(s):

Joel David

, Anne Miller

, Anushka Soni

, and Lyn Williamson

DOI:
10.1093/med/9780199587506.003.0034
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date: 23 August 2019

A 72-year-old man had been under the care of the rheumatology department for 3 years with a polyarthritis involving his hands, knees, and ankles. The hands had been especially uncomfortable across the wrists and MCPs. The blood tests had been normal apart from an elevated CRP of 25–30 mg/L. A diagnosis of RA had been made, although the RF and ACPA tests were negative, X-rays did not demonstrate erosions, and there was no family history of RA or autoimmunity.

The past medical history included chronic bronchitis, probably smoking-related, although he had stopped smoking 18 years previously. Medications included simvastatin for elevated cholesterol and low-dose aspirin. His RA was treated with sulfasalazine 2 g daily for 2.5 years.

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