A client presents to the orthopedic clinic for evaluation since the primary care provider thinks the client may have rheumatoid arthritis (RA). Which statement by the client correlates with the diagnosis of RA? Select all that apply
A) "I'm having a hard time opening doors since it hurts so bad."
B) "Look, I didn't button all my shirt buttons…it just hurts too much and look at the swelling in my hands."
C) "Look how my hand is deformed. My doctor calls it 'hyperextension.'"
D) "Just look at my face. It looks like I have varicose veins on my cheeks."
E) "Every time I get something out of the freezer, my hands turn reddish purple in color."
Ans: A, B, C
Feedback:
Rheumatoid arthritis (RA) joint involvement usually is symmetric and polyarticular. Pain with turning door knobs, opening jars, and buttoning shirts is commonly reported due to swelling of the wrists and small joints of the hand. Hyperextension of the PIP joint and partial flexion of the distal interphalangeal (DIP) joint is called a swan neck deformity. As the RA inflammatory process progresses, synovial cells and subsynovial tissues undergo reactive hyperplasia. With osteoarthritis (OA), joint changes result from the inflammation caused when the cartilage attempts to repair itself, creating osteophytes or spurs. Raynaud phenomenon (a vascular disorder characterized by reversible vasospasm of the arteries supplying the fingers) and telangiectasia (dilated skin capillaries) are characteristic of scleroderma.
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