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under upervised miss Islam AL-shami

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Saja madaremah

on 30 November 2014

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Transcript of under upervised miss Islam AL-shami

trigger is viral or bacterial infection .
has articular manifestation that involve chronic chronic inflammation that begin in the synovial membrane and progresses to subsequent damage in the joint cartilage .
some studies suggest tea cause RA
, but
another say it protective from RA .
medical management
Drug therapy :
under supervised


Islam AL-shami

MD ,nutritionist

Rheumatoid arthritis
chronic , inflammatory ,autoimmune disease

cause is unknown ,certain gene play role in

our case today
**present case study

made by

saja A. madremah

present by:
islam saeed
sara khald
assel abbas
saja ahmad
occur more frequently in woman than in men ,
commonly occur between 20-45 years of age .

choice of drug class and type is based on pt`s response to Med. ,incidence ,severity of illness.
salicylates and NSAIDs commonly used .
DMARDs to slow or prevent joint damage .
MTX( homocystein
, folat antagonism)
gold salt and D-penicillamine therapy
( proteinuria)
surgery :
surgery considered if pharmacological and non-pharmacological can not adequately control the pain and acceptable level of function .
joint replacement .
tendone reconstruction
Around the joints
limitations in joint motion


Glucocorticoids ,e.g: prednisone

basic information
-Richard jacobs , male, caucasian , 39 yo

-occupation : employment counselor
(M-F 9-6 PM)

- live alone
chief complaint :
-morning stiffness is considerably worse and actually last almost noon .

-weak up during night with pain.

Pt`s history:
onset disease 5 year ago Dx with RA
type of Tx Motrin 1000mg , prednisone 10mg/day

PMH no significant illness .

Smoker yes

family Hx yes
HTN who ? richard`s father
physical exam
Nutrition Tx :
evaluate his intake by computerized dietary analysis.
abnormal lab value
blood glucose(70-100) 119

uric acid 9.2
(4-9) 9.2 H

ESR 33 (0-15) 33
MT rate
intake-related nutrition problem.:
usual intake
requirement is
* BMI= 21.8 (healthy weight)

*%IBW=current wt/IBW *100%
= 70/78*100% = 90%
*%UBW= current wt/UBW*100%
= 70/75*100%= 93%
>> sever wt loss

** we can use AMA to assess lean body mass.

Harris-benedict equation:
66.473+(13.7516*70)+(5.0033*179)-(6.7550*39)=1661 kcal
>> S.f (1.14-1.35)>> suppose it 1.2
>> Activity factor >> 1.1
>> So energy req. =1661*1.3= 2159 kcal

*protein req.(1.5-2)g/kg
= (105-140)g

Focus on omega-3 fats & vegetable oil (which is have anti-inflamatory effect).
folic acid supplementation
Vit B12, B6, D & Ca supplementation

why ??
appetite fair(hungrier when pain is controlled.
inadequate intake generally and high coffee consumption.
what is kosher Diet
lBM loss
indicate and why loss
all of them WNL ,but
neurological: alter and oriented

mild limitation in motion ,bony enlargement of distal inter phalanges.
-elbow, shoulder ,wrists ,small joint of feet are swelling.
problem and goal ::
difficult in motion
sedentary life style .
muscle loss function .
loss appetite
difficult in shopping and preparing food.
dryness of mouth; xerostomy
-jewish practice,

total separation of meat and dairy products. Meat and dairy may not be cooked or eaten together.
these diet made meal lack from one basic nutrient .
is more strict and difficult in applied it .
weight management
ensure adequate intake by food record
asses AMA.
participant in group ,..
RA pain`s
case study "for practicing "
The patient is a 34-year-old Caucasian woman her wt is 100 kg , and ht is 170cm who initially presented to her primary care physician with a chief complaint of pain and swelling in multiple joints that made it difficult to carry out her duties as executive assistant to the vice president of a trucking company. She has been experiencing increased morning stiffness and difficulty with simple tasks such as tying shoelaces, buttoning clothes, and typing. The patient's primary care physician discussed the possibility of rheumatoid arthritis (RA) and prescribed 1 month of treatment with a nonsteroidal anti-inflammatory drug (NSAID). This treatment did not reduce the severity of the patient's symptoms and her primary care provider referred her to a rheumatologist.

Her lab test result :
WBC 8000mm3
RBC 4.5mm3
Uric acid 7mg/dl
Glucose 120mg/dl
CR-protein 2mg/dl
TG 155mg/dl

As RD check this case ?
Full transcript