RHEUMATOID ARTHRITIS

Brief History. A.T., a 75-year-old woman, was diagnosed with rheumatoid joint disease several years ago. She is currently being seen three times each week in physical therapy as an outpatient for a program of paraffi n and active exercise to her wrists and hands. Resting splints were also fabricated for both hands, and these are worn at night to prevent joint deformity. The patient was also instructed in a home exercise program to maintain joint mobility in both upper extremities. Pharmacological management in this patient originally consisted of NSAIDs, beginning with aspirin and later switching to ibuprofen. As her condition worsened, she was also placed on prednisone, an anti-infl ammatory steroid (glucocorticoid) that can decrease joint infl ammation and perhaps also suppress the autoimmune response underlying RA. Prednisone was administered orally at a dosage of 20 mg each day. Problem/Infl uence of Medication. The combination of an NSAID, a glucocorticoid, and the physical therapy program seemed to be quite effective in reducing the patient’s pain and joint stiffness. However, while preparing the patient for her paraffi n treatment, the therapist noticed the skin on A.T.’s hands and wrists was very thin and bruised very easily. Likewise, her skeletal muscles were weaker than would be expected even with her advanced age, and substantial skeletal muscle wasting was apparent throughout her trunk and extremities.

1. What is causing the skin changes and muscle wasting?

2. What might be an alternative drug strategy to modify disease progression in RA?

3. What can the therapist do to try to offset the general loss of muscle mass and strength?