Initial investigation at Rheumatology Clinic
Investigation Result (normal ranges)
Haemoglobin (g/dl) 10.1 (11.5-16.0)
Platelet count (x109/l) 245 (150-400)
Total white cell count (x109/l)
neutrophils (x109/l)
Total lymphocytes (x109/l) 12.5 (4.0-11.0)
8.2 (2.0-7.5)
2.1. (1.6-3.5)
Serum immunoglobulins Normal
Serum albumin (g/l) 32 (35-50)
ESR (mm/hr) 41 (<20)
Creactive protein (mg/l) 25 (<5)
IgM Rheumatoid factor Positive
ANA Negative
dsDNA-binding activity 15%
Serum complement
C3 (g/l)
C4 (g/l)
1.02 (0.75-1.65)
0.30 (0.20-0.65)
X-ray of hands Erosion at the distal radii and metacarpophalangeal joints
Questions:
a) What condition do you think this woman is suffering from and why? Refer to the evidence presented in the case study and laboratory result (20 marks)
b) Explain what the laboratory results mean and how they can deduce a diagnosis (10 marks)
c) Discuss the role of the immune system and the possible immune mechanisms involved in this condition (20 marks)
