Case Studies

Craig I. Coleman, PharmD
Published Online: Monday, July 22, 2013
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CASE 1
JC is a 60-year-old woman with rheumatoid arthritis (RA) for the past 2 years. She presents to the clinic with worsening disease activity, complaining of increased joint pain and inflammation for the past 2 months that limits her ability to do daily activities. JC has been self-managing the pain/inflammation with naproxen for symptomatic relief. She is currently on maintenance therapy with methotrexate 15 mg a week. Because the patient’s disease activity has deteriorated, the physician contacts you for recommendations on adding or switching disease-modifying antirheumatic drugs (DMARDs).
What would you recommend for managing this disease? 

CASE 2
SF, a 54-year-old obese woman, presents to the pharmacy to pick up her prescriptions. As she waits for her medications to be filled, she complains of pain and weakness in her legs. She tells the pharmacist that it is probably from the daily jogging she has been doing for the past 6 months to lose weight. On further questioning, she notes that the pain and weakness have worsened in the past few weeks. In addition to jogging, SF has made some modifications to her diet, and her doctor changed her statin therapy from simvastatin to rosuvastatin a few weeks ago. Her medication profile currently consists of rosuvastatin 10 mg daily, levothyroxine 25 mcg daily, metformin 500 mg twice daily, glipizide 5 mg daily, gemfibrozil 600 mg twice daily, and metoprolol 50 mg daily. 
What is/are the likely cause(s) of SF’s leg pain and weakness?

Dr. Coleman is associate professor of pharmacy practice and director of the pharmacoeconomics and outcomes studies group at the University of Connecticut School of Pharmacy.


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