A 12-year-old male established patient with inflammatory bowel disease with associated juvenile spondyloarthropathy returns to the office for a follow-up visit for his infliximab infusion. The patient reports moderate pain in his right hip after walking for extended periods of time or after sports activities. He denies any other joint pain and denies any joint swelling. He has morning stiffness two to three days per week lasting approximately 30 minutes. The patient reports his appetite is great, but does have crampy abdominal pain associated with defecation and loose stools an average of two to three times per week. He is scheduled to see his gastroenterologist in two weeks for follow-up of his Crohn’s disease. The patient denies fever, rashes, chest pain, cough, headaches or allergies. The patient is an 8th grade basketball player and denies missing school due to illness. In addition to infliximab infusions every eight weeks, the patient is on methotrexate, folic acid, sulfasalazine and celecoxib.
The rheumatologist performs a detailed physical examination, which reveals irritability and decreased internal rotation in the right hip. The patient’s sulfasalazine is increased to 750 mg, and he will continue on his other medications. Routine laboratory studies and an X-ray of the patient’s right hip are ordered. Influenza vaccination is recommended, because the patient is on immunosuppressive medications. The patient is to return for follow-up evaluation in six weeks.
The patient then receives an infusion of 350 mg infliximab. The medication is started at 10:05 a.m. and completed at 12:25 p.m.