A 32-year-old woman comes to the physician because of pain and stiffness in both of her hands for the past 3 weeks. The pain is most severe early in the day and does not respond to ibuprofen. She has no history of serious illness and takes no medications. Vital signs are within normal limits. Examination shows swelling and tenderness of the wrists and metacarpophalangeal joints bilaterally. Range of motion is decreased due to pain. Laboratory studies reveal a hemoglobin of 9.8 g/dL and MCV of 86. The patient is prescribed methotrexate therapy. Laboratory results 6 months later reveal that hemoglobin has increased to 12 g/dL. If measured, which of the following changes were most likely present in this patient before the start of methotrexate therapy?

Question

A 32-year-old woman comes to the physician because of pain and stiffness in both of her hands for the past 3 weeks. The pain is most severe early in the day and does not respond to ibuprofen. She has no history of serious illness and takes no medications. Vital signs are within normal limits. Examination shows swelling and tenderness of the wrists and metacarpophalangeal joints bilaterally. Range of motion is decreased due to pain. Laboratory studies reveal a hemoglobin of 9.8 g/dL and MCV of 86.  The patient is prescribed methotrexate therapy.  Laboratory results 6 months later reveal that hemoglobin has increased to 12 g/dL.  If measured, which of the following changes were most likely present in this patient before the start of methotrexate therapy?

Quizplus · Accepted Answer

Eductional Objective: Anemia of chronic disease is caused by elevated inflammatory cytokine levels (eg, hepcidin), which increase sequestration of iron within the reticuloendothelial system and reduce circulating iron levels.  Many patients have improvement in anemia with treatment of the underlying condition that caused the inflammation.

A 32-Year-Old Woman Comes to the Physician Because of Pain