This patient also has an identical past medical and surgical history as our last case, as these ailments are very common with this age group.
Looking at the review of systems, the real question with this patient is whether the arthritis is rheumatoid arthritis or osteoarthritis, as we know the lungs may be affected first in patients with RA. This is why the recommendation for serology is for an ANA, ESR, and rheumatoid factor, because a significant number of cases of rheumatoid arthritis will present first with underlying lung disease. Asymptomatic lung disease may occur in up to 60% of cases of rheumatoid arthritis, and 10% of cases will have significant, clinical interstitial lung disease.
So, when we look at the patient's social history, we again see tobacco use and a history of work as a mechanic, but this patient’s home is 125 years old. A 125-year-old home is far more likely to have had water seepage at one point and, if brick is present, may become laden with water even if everything has been properly taken care of. Mold is often present, whether the patient has remediated the home or not.
