A 62-year-old obese woman presents to the emergency department with a painful right shoulder. She has aggressive rheumatoid arthritis with multiple joint involvements. She had previously complained of right shoulder joint stiffness, but she has been experiencing severe pain in her shoulder over the past week. This is associated with worsening general malaise.
Her medical history includes stage 3 chronic kidney disease. She takes methotrexate (10 mg once a week) and ramipril (5 mg daily). Examination Cardiorespiratory and abdominal examinations: Unremarkable Right shoulder joint: Tenderness to palpation Mild erythema over the right shoulder Shoulder X-ray: Osteopenic bones but no joint abnormality Temperature: 37.9°C Heart rate: 92 beats/min Blood pressure: 100/65 mmHg SaO 2 : 93% on room air What is the differential diagnosis in this case? What treatment should be prescribed to the…
