Pain in right shoulder
This patient's joint pain kept her out of work for several years. While x-rays of her hands appeared normal, an x-ray of her shoulder exposed the underlying problem.
Treat with disease-modifying antirheumatic drugs
Immediate treatment of RA with disease-modifying antirheumatic drugs (DMARDs) is important to achieve control of the disease and prevent disability.
Our patient. We ordered a purified protein derivative skin test in preparation for the patient to start therapy with a DMARD. Our patient followed up with Rheumatology and was started on indomethacin, with an initial dose of 25 mg bid. (DMARDs are first-line therapy; indomethacin is a second-line choice. In this case, the patient declined DMARDs after hearing they lowered the body’s ability to fight infection.) An RF level measured 6.74 IU/ml, which is within normal limits. The patient was subsequently lost to follow-up.
CORRESPONDENCE
Barbara Kiersz, DO, 6835 Austin Center Blvd., Austin, TX 78731; bmkiersz@gmail.com.
