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Topics: Immune system, Rheumatoid arthritis, Antibody Pages: 6 (1263 words) Published: August 22, 2013
Details of patient.
Name : Mr. Black
Age : 64
Occupation : Retired Process worker
Signs and Symptoms
Pains in Joints. Mainly ankles and wrists.
General aches and pains in his joints.

-occurring gradually for a few months. Could be due to wear and tear of the tissues in the joints as he is 64 years old.

Ankles and wrists were mainly affected by the pains.
Probably due to overuse of his wrists and ankles over a long period of time as he was a process worker. This pain could also be due to post traumatic Arthritis. The pains are probably not caused by Rheumatoid Arthritis or Osteoarthritis because Rheumatoid Arthritis is more common in women than in men and Osteoarthritis affects men before the age of 55.

Cold and whitened fingertips

Tips of his fingers had become whitened and felt cold.
This could be because of reduced blood supply to the fingers. He may have been exposed to low temperatures for long periods of time.

Wrinkles in his hands were disappearing.
The wrinkles in his hands were disappearing and the skin on his hand seemed to become tighter. Could be due to scleroderma, a change in skin condition.
Scleroderma is an autoimmune disease.

Discolouration of fingers followed by increased blackening.
His hand had started to discolour.
Maybe he has focal pattern vitiligo which discolours the skin due to lack of melanin Could also be Raynaud’s phenomenon.

After the discolouration, his hand had become increasingly blackened. Gangrene could be a reason for this. Another would be frostbites. Or even diabetes.

Dryness and soreness of mouth and eyes.
Mr. Black complained of dryness and soreness of the mouth and eyes. Probably because the moisture producing glands are being attacked. causing the disruption of saliva and tears being produced.
Could be a case of Sjogren’s syndrome.

Dysphagia.
Mr. Black had difficulty swallowing.
Dysphagia can occur due to old age
very possible in this case as Mr. Black is 64 years old.
Dysphagia can also occur in people with scleroderma.
Another possibility would be Xerostomia
Patient experiences dry mouth due to lack of saliva in Xerostomia. Xerostomia is caused by the reduced function of the salivary gland.

Increasingly flatulent, severe diarrhea followed by spells of constipation. Probably due to digestive imbalance such as indigestion and gas. Can be caused by having too much of processed food without proper nutrition.

Results of investigations and examinations.
Full blood count.
Mr. Black’s full blood count were within the normal range. He does not have anemia, where the blood count falls below the normal range Does not have polycythemia vera, where the blood count is above the normal range. Does not have leukopenia either.

Erythrocyte Sedimentation Rate.
Although his full blood count is within normal range, his Erythrocyte Sedimentation Rate is 35 mm/hr. His Erythrocyte Sedimentation Rate is much higher than 20 mm/hr which is the normal rate for men above the age of 55. An increased Erythrocyte Sedimentation Rate shows that Mr. Black may have an auto immune disease.

Serum Electrophoresis.
Mr. black has a high level of polyclonal hypergammaglobulinaemia . This indicates high levels of immunoglobulins in his blood.
More than one type of immunoglobulin associated.
Condition is due to an infection and is not malignant.
Test would have shown monoclonal hypergammaglobulinaemia if malignant.

Serum Immunoglobulin levels.
Increased levels of Mr. Black’s immunoglobulin levels.
His IgG was 35 g/l. Normal range of IgG in healthy adults is between 6.2 g/l to 14 g/l. His IgA level was 8 g/l. Normal range of IgA in healthy adults of IgA is between 0.8 g/l to 3.5g/l His IgM level was 12 g/l. The normal range of IgM in a healthy adult is 0.45 g/l to 2.5 g/l. Shows that his body is making more immunoglobulins to fight off infections.

X-Rays.
His X-Ray result show that the ‘Arthritic’ joints
Thickening of the...

References: http://www.sclero.org/medical/about-sd/a-to-z.html#sd
http://www.patient.co.uk/health/Scleroderma-Systemic-Sclerosis.htm
http://www.sclero.org/
http://umm.edu/health/medical/reports/articles/scleroderma
http://www.sclero.org/medical/diagnosis/difficult/a-to-z.html#biopsies
http://www.sclero.org/medical/diagnosis/tests/a-to-z.html#general
http://rheumatology.oxfordjournals.org/content/45/suppl_4/iv43.full
http://www.scleroderma-info.com/2009/landingp2.php?gid=RH010&?a=a&assoc=Google&keyword=scleroderma
http://health.nytimes.com/health/guides/disease/scleroderma/
http://health.nytimes.com/health/guides/disease/scleroderma/treatment.html
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