Linda is a 33-year-old Mexican female, team manager at a service company and mother of two. She is an active smoker with

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Linda is a 33-year-old Mexican female, team manager at a service
company and mother of two. She is an active smoker with periodontal
disease. Six months ago, she presented with chronic additive
symmetric polyarthritis, involving the wrists, hands, knees, and
toes. Linda has morning stiffness for about an hour, her symptoms
improve with movement and worsen with rest. She has taken several
NSAIDs with no major improvement. At examination, the doctor noted
inflammation in the joints.
Laboratory tests showed mild normocytic normochromic anemia,
elevated erythrocyte sedimentation rate, and high C-reactive
protein. She was positive for rheumatoid factor and antibodies to
cyclic citrullinated peptide (ACPAs). Marginal erosions in the
metacarpophalangeal joints were found by x-ray imaging.
Linda was diagnosed with rheumatoid arthritis. Based on
polyarthritis, positivity of antibodies and erosions, it was
determined to be a severe case, and she was started on
disease-modifying antirheumatic drugs (DMARDs) methotrexate (MTX)
and corticosteroids.
Patient is 33-year-old woman with a recent diagnosis of
rheumatoid arthritis.
Anthropometric Data
Ht 5´8” (1.73m); Wt 152 lb (69 kg)
(lost 6 lb over past 2 months)
BMI = 23
Biochemical data: Hgb 10.5 g/dL
Food and nutrition history
Nutrition diagnostic statements
Interventions
Monitoring and evaluation
1. Evaluate energy, protein, iron and vitamin intake. If
arthritis is not active, adjust protein to 1 g/kg BW.