Patient A
A 50-year-old male patient diagnosed with ankylosing spondylitis comes to the office for a routine follow-up visit and weekly methotrexate injection. The patient reports increased low back pain and stiffness for the previous three weeks, which is interfering with his recreational activities and ability to perform household chores that require bending and lifting. The patient states he has no other musculoskeletal pain or any joint swelling. The problem-pertinent review of system is negative. He is on indomethacin, weekly methotrexate 10-mg SQ injections, and folic acid. The physician performs an expanded problem-focused exam. Routine labs are ordered. The patient’s methotrexate is increased to 15 mg SQ week and he is advised to continue taking his other medications. The patient then receives a methotrexate 15-mg SQ injection prior to leaving the office.
Patient B
A 43-year-old female patient diagnosed with RA comes in for a follow-up visit. She still has severe pain, stiffness, and swelling in her elbows and wrists. She denies any fevers, cough, dyspnea, or concurrent illness. She is on a nonsteroidal antiinflammatory drug, folic acid, and ranitidine. The physician performs an expanded problem-focused exam and reviews labs ordered during the last visit. The physician decides to give a 10-mg injection of myocrisin to the patient and discusses starting her on methotrexate in the near future.
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