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I've had it." Which of the following is the most appropriate response? The patient says, "I cannot continue to live as I am. Physical examination discloses marked joint deformities in the hands, wrists, shoulders, and feet the findings are unchanged from previous visits. She tells you that her husband of 30 years left her 6 months ago. Medications include etanercept, methotrexate, prednisone, and tramadol. Medical history is otherwise unremarkable. She has difficulty bathing and dressing, but she is able to stand and walk independently. Rheumatoid arthritis was diagnosed at age 35 years, and the patient has been unable to work for the past 10 years. Which of the following cell types is most affected by this patient's condition?Ī 54-year-old woman with severe rheumatoid arthritis comes to the office for a routine follow-up examination. Sensation to pain and temperature is decreased at the lower costal margin and below, most pronounced on the right. Proprioception and sensation to vibration are absent over the left lower extremity and decreased over the right lower extremity to the level of the hip. Deep tendon reflexes are normal in the upper extremities but hyperactive in the lower extremities, especially on the left. Examination shows spastic lower extremities and moderate weakness of the left lower extremity, more prominently in the flexor than in the extensor muscles. His temperature is 37☌ (98.6☏), pulse is 55/min, respirations are 10/min, and blood pressure is 110/70 mm Hg. He is 157 cm (5 ft 2 in) tall and weighs 55 kg (121 lb) BMI is 22 kg/m 2. He had an episode of optic neuritis in the right eye 3 years ago. He began to notice some problems with his balance 2 days ago, and his walking has become progressively worse since then. A 27-year-old man is brought to the emergency department by his roommates because of an inability to walk.