Case study A 49-year-old Patient with Rheumatoid Arthritis

Case study A 49-year-old Patient with Rheumatoid Arthritis

An individual’s genetics and environment play a huge role in determining how much they are predisposed to certain health conditions and genetics. These factors also influence how the disease affects body systems and how patients present symptoms related to the disease. The scenario of focus in this case study involves a 49-year-old patient with rheumatoid arthritis who visited the clinic due to fever. In this regard, it is important to explain or determine the reasons for the symptoms the patient presents, related genes, and the process of immunosuppression and its effect on body systems.

Reasons for Symptoms the Patient Presents

The symptoms presented by the patient include fever, chills, sweats, fatigue, chest pain with coughing, and occasional hemoptysis. There are a number of reasons the patient presented these symptoms. Firstly, the symptoms can result from a fungal infection that affects the respiratory system. Noting that the 49-year-old patient works as a grain inspector, they are exposed to mold from grains and the storage environment. Fungal infections such as invasive aspergillosis are majorly manifested by the symptoms the patient presents, such as coughing, fever, and chest pain (Centers for Disease Control and Prevention, 2020). Invasive aspergillosis is also common among ill patients with compromised immune systems (Jenks et al., 2021). The patient has an existing case of rheumatoid arthritis, meaning he already has a compromised immune system. The patient is also taking immunosuppressive medications such as methotrexate and prednisone, which are used for the management of rheumatoid arthritis (Hresko et al., 2022). This further suppresses his immunity and exposes him to fungal infections such as aspergillosis based on his work environment, which leads to the manifested symptoms.

Genes Involved in the Development of Invasive Aspergillosis

The development of invasive aspergillosis is associated with genes related to a functional immune system, especially those that influence the activity of immune cells, particularly cytokines and chemokines. These include all immune cells involved in the development of innate and adaptive immunity. These include IL-9, TNF-α, IL-1, INF-γ, IL-17A, and IL-10 (Maia et al., 2020). The actual gene expression of these cytokines depends on the nature of the trigger, such as a pathogen, including the fungal infection, as an inflammatory response, or as a result of interactions between immune cells, noting that the patient has rheumatoid arthritis.

The Process of Immunosuppression and Its Effect on Body Systems

Immunosuppression involves the intentional or unintended reduction of the strength and activity of the immune system. In the case of the 49-year-old patient, immunosuppression is induced to help manage their case of rheumatoid arthritis using medications. The use of immunosuppressants, as in the case study, controls how the patient’s immune system responds to inflammation. For instance, both methotrexate and prednisone work by reducing the production of inflammatory mediators, especially cytokines, which, in turn, inhibit the activation and proliferation of T cells and B cells, hence suppressing the individual’s immune responses to inflammation or infections.

Immunosuppression has a significant effect on body systems. Firstly, it reduces the activity of the individual’s immune system by controlling how immune cells are produced and activated. This reduces the ability of the immune system to detect infections and respond accordingly. Immunosuppression can reduce the inflammatory response and help manage conditions such as rheumatoid arthritis and other autoimmune disease; it reduces the body’s defense against infections. Additionally, immunosuppression can impair metabolism with an impact on how the body utilizes nutrients, with a risk of developing weight and bone issues.

Summary

The 49-year-old patient’s symptoms result from environmental exposure to mold infection, compromised immunity due to having rheumatoid arthritis, and the use of immunosuppressive medications such as methotrexate and prednisone. All these increase the risk of an invasive aspergillosis infection with which the patient has been diagnosed. Immunosuppression reduces immune system activity and increases the risk of infections. In conclusion, multiple factors, an individual’s genetic makeup combined with their environment and health status, increase their susceptibility to certain diseases.

 References

Centers for Disease Control and Prevention. (2020, November). Types and symptoms of aspergillosis. CDC. https://www.cdc.gov/fungal/diseases/aspergillosis/symptoms.html

Hresko, A. M., Got, C. J., & Gil, J. A. (2022). Perioperative management of immunosuppressive medications for rheumatoid arthritis. The Journal of Hand Surgery, 47(4), 370–378. https://doi.org/10.1016/J.JHSA.2021.09.038

Jenks, J. D., Nam, H. H., & Hoenigl, M. (2021). Invasive aspergillosis in critically ill patients: Review of definitions and diagnostic approaches. In Mycoses (Vol. 64, Issue 9). https://doi.org/10.1111/myc.13274

Maia, L. M., Espaladori, M. C., Diniz, J. M. B., Tavares, W. L. F., de Brito, L. C. N., Vieira, L. Q., & Sobrinho, A. P. R. (2020). Clinical endodontic procedures modulate periapical cytokine and chemokine gene expressions. Clinical Oral Investigations, 24(10). https://doi.org/10.1007/s00784-020-03247-y

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Hello. Below is the case study to use for this assignment, and I also attached the format to be used for the assignment.

Case study A 49-year-old patient with rheumatoid arthritis comes into the clinic with a chief complaint of a fever. The patient’s current medications include atorvastatin 40 mg at night, methotrexate 10 mg PO every Friday morning, and prednisone 5 mg PO qam. He states that he has had a fever of up to 101 degrees F for about a week and admits to chills and sweats. He says he has had more fatigue than usual and reports some chest pain associated with coughing. He admits to having occasional episodes of hemoptysis. He works as a grain inspector at a large farm cooperative. After extensive work-up, the patient was diagnosed with Invasive aspergillosis.

An understanding of cells and cell behavior is a critically important component of disease diagnosis and treatment. However, some diseases can be complex in nature, with a variety of factors and circumstances impacting their emergence and severity.

Effective disease analysis often requires an understanding that goes beyond isolated cell behavior. Genes, the environments in which cell processes operate, the impact of patient characteristics, and racial and ethnic variables all can have an important impact.

An understanding of the signals and symptoms of alterations in cellular processes is a critical step in the diagnosis and treatment of many diseases. For APRNs, this understanding can also help educate patients and guide them through their treatment plans.

In this Assignment, you examine a case study and analyze the symptoms presented. You identify cell, gene, and/or process elements that may be factors in the diagnosis, and you explain the implications to patient health.