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1601006090 LONG CASE

 

1601006090 LONG CASE


A 50 year old female came to the OPD with chief complaints of pain and stiffness in several joints since 3 months

History of present illness:

She was apparently asymptomatic 8 years ago, then she developed a dull aching type of pain and stiffness in her finger joints(MCP joints) of right hand.

Then after 4 months of onset, the pain and stiffness progressed to invovle other joints( wrist joint and elbow joint) of both hands and ankles

Pain was insidious in onset, slowly progressive, dull aching type, non radiating,associated with swelling and limitation of movements of the involved joints, 

Since 3 months the pain increased limiting  her activities

Stiffness and pain was more in the morning for 1 hour after waking up and gradually improved on movement.

Sometimes pain was associated with intermittent fever.

No deformities 

No loss of weight.

Past history:

She has no similar complaints 8 years ago. 

No history of thyroid, Asthma, hypertension, diabetes 

No known drug allergies

Menstrual history:

Menarch: 13 years 

Regular 29 day cycles 

Menopause: 47 years 

Family history:

No similar complaints

Personal history:

Diet: mixed 

Appetite: normal 

Bowel and bladder: regular 

Sleep: adequate 

General examination:

patient is conscious coherent and cooperative 

Moderately built and nourished 

No pallor 

No icterus

No edema

No cyanosis 

No lymphadenopathy 


Vitals:

Temperature: afebrile 

Blood pressure: 115/70

Respiratory rate: 15cycles /min

Pulse rate: 80bpm

Local examination:

INSPECTION 

Skin : 

No pigmentation 

No scars 

No atrophic changes 

Nails: normal 

 swelling over the joints 

Deformities : no deformities 



PALPATION

Skin: warm

Sensations are preserved 

Soft tissues: no edema 

Joint capsule: mild swelling over the joint 

Tenderness over the joint (squeeze test)

Movements: 

Decreased range of movements at PIP, MCP, wrist, elbow, ankle joints 

All active and passive movements at the involved joints and painful.



Extraarticular manifestations:

Eyes: no dryness of eyes(keratoconjuctivitis sicca)
Ear: no hearing loss
Muscle : no muscle atrophy
GIT: no xerostomia, no parotid gland enlargement, no dysphasia
No lymphadenopathy 

Systemic examination:

CARDIOVASCULAR SYSTEM

Apex beat: 5th intercostal space lateral to midclavicular line 

S1 and s2 heard 

No murmers  , no palpable thrills

JVP normal

Pedal edema: absent 

RESPIRATORY SYSTEM:

Breath sounds: normal 

No additional breath sounds 

CENTRAL NERVOUS SYSTEM:

cranial nerves intact 

Reflexes preserved

Sensations preserved 

Joint position sense: intact 

ABDOMEN

No abnormal findings found

DIFFERENTIAL DIAGNOSIS

1. Rheumatoid arthritis 

2.Osteoarthritis

INVESTIGATIONS:

1. Complete blood picture 

2. ESR 

3. CRP

4. Rheumatoid factor 

5. Liver function tests 

6. Renal function tests 

7. Urine examination 

8. Antibodies 

9. X-ray 








PROVISIONAL DIAGNOSIS:

RHEUMATOID ARTHRITIS 



Treatment:

1.Prednisolone

2.Hydrocortisone sodium

3.Tramadol


                                              





 

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