Case Study: Rheumatoid Arthritis
Mr. Y is a 47 year old, mixed race [Asian/African ethnicity], male patient who presented to your office with
severe right great toe pain. Onset of the pain was 2 days ago. Mr. Y denies any known trauma to his right foot or
his great toe on that foot. His right great toe is red and became so swollen in the last day that he cannot put on
his shoe.
Mr. Y has a history of hypertension for which he is taking HCTZ 25mg daily, Metopralol 50 mg twice daily, and
Lisinopril 10 mg daily. He denies any other medical problems.
Results of the lab tests that were ordered:
Sed rate — 93; Glucose, random — 117 mg/dl; Hgb – 13.4 gm/dl; WBC — 8200/ccm with normal diff; Serum uric
acid — 10.9 mg/dl; Serum creatinine — 1.2 mg/dl
Assignment Questions

1. Based on presenting symptoms and lab findings, what is most likely diagnosis that will be made for Mr. ¥?
2. What is the anticipated pharmacologic plan for managing Mr. Y’s acute pain? Provide a justification for the
   plan including a citation from a peer-reviewed source.
3. What is the anticipated pharmacologic plan for long-term management of Mr. Y’s diagnosis? Provide a
   justification for the plan including a citation from a peer-reviewed source.
4. Identify the key elements of the education plan that would be appropriate for the patient about the acute and
   chronic pharmacologic plans you identified above.