❓ Did you know that social determinants of health could be worsening outcomes for some of your patients with rheumatic disease? MedEd CME HealthEquity 📝
The following cases are modeled on the interactive grand rounds approach. The questions within the activity are designed to test your current knowledge. After each question, you will be able to see whether you answered correctly and read evidence-based information that supports the most appropriate answer choice. The questions are designed to challenge you; you will not be penalized for answering the questions incorrectly.
Isabel immigrated from Guatemala over 30 years ago and is now a naturalized citizen, but she is still less confident in her ability to communicate in English rather than in her native language of Spanish. Isabel’s daughter, Pía, accompanies her to the appointment to assist. Pía reports that Isabel was referred to your clinic 3 months ago but had been unable to get an initial appointment until now.
On physical exam, her blood pressure is 110/70 mm Hg, heart rate 81 bpm, and her temperature is 99.5°F. Joint counts confirm the presence of 24 tender joints and 22 swollen joints, in a symmetrical pattern. No skin findings or nodules. Other body systems appear normal. Based on her history and presentation, you order further workup.
Laboratory studies are significant for an erythrocyte sedimentation rate of 35 mm/h , C-reactive protein of 4 mg/dL , and positivity for rheumatoid factor and anticitrullinated protein antibodies . Ultrasonography and x-ray findings also show changes of RA in the metacarpophalangeal and proximal interphalangeal joints of the hands, and the metatarsophalangeal and proximal interphalangeal joints in the feet.
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