The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case that you would like to suggest for a future Case Challenge, please contact us.
A 45-year-old woman who has a history of rheumatoid arthritis presents to her primary care physician's office with weakness of the right hand. Several weeks earlier, she had had some difficulty in fastening the buttons on her blouse. Later she had problems writing with a pen. At first, she had attributed these difficulties to her rheumatoid arthritis, but when she noticed actual weakness of her right hand, she sought medical attention.
Several years ago, pain and swelling had developed in her joints, particularly those of the hand and wrist. Eventually, a diagnosis of rheumatoid arthritis was made. Methotrexate was prescribed, but it caused diarrhea and some bleeding from her gums, and she stopped taking the medication. Her joint symptoms persisted, particularly those involving her fingers, wrists, elbows, and shoulders. She currently manages these symptoms with naproxen alone and rarely visits her physician.
Otherwise, the patient's general health is good. She takes no other medications. Her surgical history includes an appendectomy and a hysterectomy. She does not smoke or use illicit drugs, and she drinks alcohol only occasionally.
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Cite this: Anthony H. Woodward. Worsening Hand Weakness in a 45-Year-Old Woman With RA - Medscape - Jun 09, 2023.