Probable Diagnosis

 

Probable Diagnosis

Based on the symptoms described, the probable diagnosis for the 32-year-old nurse is Rheumatoid Arthritis (RA).

Other Possible Diagnoses

While RA is the most likely diagnosis, it is important to consider other possible diagnoses that present with similar symptoms. These may include:

Systemic Lupus Erythematosus (SLE): SLE can cause joint pain, stiffness, and swelling, along with other systemic symptoms such as fatigue and malaise. However, the absence of fever, chills, skin rashes, and weight loss makes SLE less likely in this case.

Psoriatic Arthritis: Psoriatic arthritis can cause joint pain and stiffness, typically in association with skin manifestations such as psoriasis. The absence of skin rashes in this case makes psoriatic arthritis less likely.

Spondyloarthropathies: Conditions like ankylosing spondylitis or reactive arthritis can present with joint pain and stiffness, particularly affecting the spine and lower extremities. However, the involvement of hands and wrists in this case suggests a different diagnosis.

Diagnostic Studies and Basic Treatments

To confirm the diagnosis and initiate appropriate treatment, the following diagnostic studies and basic treatments are most appropriate:

Diagnostic Studies:

Rheumatoid Factor (RF) Test: RF is an antibody commonly found in patients with RA. Although it is not specific to RA, a positive RF test can support the diagnosis.
Anti-Cyclic Citrullinated Peptide (anti-CCP) Antibody Test: This test is highly specific for RA. A positive result can further support the diagnosis.
Complete Blood Count (CBC): CBC can reveal anemia of chronic disease, which is common in RA. It can also help assess for any underlying infection.
Erythrocyte Sedimentation Rate (ESR) or C-Reactive Protein (CRP): These tests measure inflammation levels in the body and can assist in the diagnosis and monitoring of RA.
X-rays: X-rays of affected joints can help detect erosions or joint damage, which are characteristic of RA.

Basic Treatments:

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): NSAIDs can provide symptomatic relief by reducing pain and inflammation. They can be used as needed during flare-ups.
Corticosteroids: Short-term use of oral or intra-articular corticosteroids may be considered for severe symptoms during flare-ups.
Disease-Modifying Antirheumatic Drugs (DMARDs): DMARDs, such as methotrexate or hydroxychloroquine, are used to slow down the progression of RA and reduce joint damage.
Patient Education: Educating the patient about RA, its chronic nature, and the importance of adherence to treatment is crucial for long-term management.

It is important to note that the final diagnosis and treatment plan should be made by a healthcare professional based on a comprehensive evaluation of the patient’s history, physical examination, and diagnostic results.

Reference: https://emedicine.medscape.com/article/331715-overview