CASE HISTORY – January 2007

Natural course of rheumatoid arthritis: a case report


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We present a case report of a 45-year-old woman who is diagnosed with rheumatoid arthritis (RA) 23 years ago. It illustrates the chronic mutilating course of RA without adequate treatment. RA management guidelines designate early aggressive DMARD (disease modifying antirheumatic drug) therapy. The patient is extremely cachectic, completely bedridden. Deformations typical of advanced RA have developed in multiple joints. Laboratory findings include anaemia, and moderate inflammatory activity. The results of investigations show atlantoaxial subluxation (surgically not manageable) and severe osteoporosis. The patient did not agree with any treatment related suggestions made by doctors.
Today primary care physicians are more aware of RA and refer the patient to the rheumatologist in time to  start DMARD therapy. Precise monitoring of side effects and disease progression is essential. Even if we can minimize the shortcomings of RA management within the health care system, we cannot totally eliminate patient related factors. The potential failure of therapy can be avoided bearing in mind that every drawback reduces compliance to treatment. It is important that the patient understands what to expect, making minor downsides more tolerable. Compliance is influenced by the patient-doctor relationship, other persons’ experiences, inner beliefs, and other patient related factors. The above case provided a chance to document an unsuccessful treatment of RA. Several issues both on the side of the patient and the medical system have contributed to such disease progression.