Healthcare plan template
Patient name Date completed
Anna
Case Study
The patient is a 52-year-old female with rheumatoid arthritis called Anna.
Anna works in a college, teaching health and social care. She first noticed she had a problem when
she was 28, she was working as a midwife and realised she had a problem when she started to
struggle getting up from the floor. At first, she put this down to being overweight, before realising
there was a deeper problem, at the age of 30. She would have different issues daily, with random
symptoms, one day having a painful knee, hot to touch and inflamed, and the next, having a
painful hand. She started to notice she was waking up with her hands clenched, and they took a
while to open again, which then affected her work, as she could not perform daily tasks such as
taking blood pressure. All her joints ached randomly with no explanation of why. She found her
symptoms were worse in the morning and night, and by the middle of the day, was fine again and
pushed the thought of it being an issue to the side. She then went to see a physio following a stiff
and painful neck, which led to her being able to fully move her neck again. By the time she was 30,
she was a practice nurse, and she started to go to her own GP. She told him all her symptoms,
including tiredness which she now felt very often, but would then put it down to age and weight,
and carried on with their conversation. She then got pregnant and had her baby at 32, and had no
symptoms for her whole pregnancy, and decided her symptoms must have been anxiety induced,
as she had IVF, and a stressful job. She found that over the course of the month, her symptoms
got worse. At age 33, she started to struggle to lift her baby out of her cot, as well as struggling to
dress herself, carry her baby, and struggling to walk down the stairs in the mornings. She also felt
overwhelmingly tired and would fall into deep sleeps often in the middle of the day. She noticed
extreme pain in her hands and feet and felt as though she was walking on pebbles. When she was
34, she went on holiday with her family, her cousin also had rheumatoid arthritis, and through a
conversation with him, they realised her symptoms were very similar to his, and he suggested the
possibility of her having rheumatoid arthritis. She had flu like symptoms and was stuck in bed
unable to move. When she got back, she went to see a locum, which was in replacement of her
usual doctor. She was a new doctor and was very keen and kind. She did a full body check and
blood test, which came back negative for rheumatoid, however they decided the results were
wrong, and she did in fact have arthritis, and was referred to a specialist at age 36. The specialist
said the wait was a 12 week wait, but due to private health insurance, she managed to get an
appointment the next day. He did more tests which confirmed she did have it, and she was
prescribed medication. The consultant asked about her concentration, which she struggled with,
and this links highly to arthritis. The medication she was put onto, was called Methotrexate, and
was an immunosuppressant, as her immune system was attacking her joints, bones, and muscles.
The medication slows her immune system and helped to reduce inflammation. It can be very
dangerous and can only be taken once a week as it is so powerful. She was also put onto
sulfasalazine. They also injected her with a steroid to take away the pain, as well as folic acid to
counteract the methotrexate. She suffered with hair loss, indigestion, heart burn, nausea, and
headaches due to the drugs she was on. As she was private, she got 3 years’ worth of treatment in
one year and was seen often. She was then put onto etanercept a year later, which she is still on
, now, as her other drugs weren’t working. The other drugs were slowly phased out. She takes
etanercept by herself at home and has been on it 15 years taking it as an injection once a week.
When she first started, she got a skin rash on her stomach, but only for the first month. She was
watched injecting it by a rheumatoid specialist her first time, but now does it herself at home.
Every 3 months, she has blood tests to check for liver, kidney function and inflammatory
processes. She has hand splints, and sometimes gets wear wrists, so uses them for support.
Without treatment, she would have experienced joint erosion.
Healthcare/support Healthcare/support People and teams Recommendations
needs approach involved in and future actions
care/support
P5 P6
P6/M4 M4
Pain management To help reduce Anna’s She saw a doctor to In the future, Anna’s
pain, medication was assess her symptoms GP should do regular
given (an and refer her to a reviews to assess her
immunosuppressant specialist who symptoms and
called methotrexate & prescribed her change medication
sulfasalazine) to prevent immunosuppressants where necessary. For
the immune system & painkillers. example, increasing
attacking joints and her dosage or
causing inflammation A GP may refer Anna switching types of
further. to an occupational painkillers if she
She was also injected therapist who may doesn’t find they’re
with a steroid to reduce help Anna to find reducing her pain.
pain. ways to reduce pain
and maintain her Also, health
Other tools may be independence (eg- professionals should
provided to Anna to wrist splint). continue to suggest
help reduce pain. For new tools to Anna to
example, a wrist splint support her with
to support the joint. This everyday tasks. For
can also help to improve example, if she begins
grip strength. to struggle turning
faucet knobs she
could switch to levers.
Many other adaptive
utensils are also
available with bigger
handles.
Losing weight may
also be recommended
to help reduce joint
pain. Anna may be
referred or refer
herself to a
nutritionist or
personal trainer to
help her with this.
