CASE OF 45YR OLD WITH RHEUMATOID ARTHRITIS
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A 45 year old gentlemen who was a farmer from suryapet came to the hospital with chief complaint of
CHIEF COMPLAINTS:-
Decreased urine output since 1 week
Joint pain since 1 week
Pain in right side lower abdomen since 10 days
HISTORY OF PRESENTING ILLNESS:-
Patient was apparently asymptomatic 4 years back
Then he developed pain in right knee which was gradual ,progressing, nonradiating, dull in nature
Pain was not aggravated while sitting or bending
After 1 month there was decrease in knee pain and then ankle started to pain
There was involvement of one joint after the another each joint pain used to last for 10 days
There was involvement of following joints
Knee
ankle
Shoulder
Elbow
Wrist
MIP
There was no involvement of proximal and distal interpharengeal joints
No involvement of back or neck
He visited a rmp after 3 months where he was given medication?
Took one per day when it hurts
There was no time when all joints were involved
There have been 2 hospital admission
First when he visited ge was treated as gouty arthritis and on investigation was done his hb was found to be 3
He was treated with B12
Then he visited our hospital again with regarding his joints for which he was admitted for 5-6 days
His hb was again found to be 3.5 which was now treated as dimorphic anemia with both iron and folic acid tablets
He is not using the given medication
He used medication for pain a month and the pain subsided for 1 month
Then the pain gradually increased by 6 months
He also stopped going to work when he was admitted and has not gone since
There are also white patches on fore head going into the hair since 4 years
There is also Increased frequency of micturation since 3-4 months
PAST HISTORY:-
N/k/c
Diabetes
Hypertension
Tuberculosis
Asthama
Daily routine
2 yrs back -
wake up at 4-5am
Eat rice
11am-12pm - work
2-3pm lunch box at work
8-9pm come back to home
Dinner-9pm
Watch tv
9:30-10pm- sleep
1yr back-
Wake up at 7am
Drink plain milk
Takes rest
9:30-10am- rice( less than before)
Time pads
2-3pm-lunch
Sleep
4-5wake up
Time pass
8pm-dinner
Sleep
PERSONAL HISTORY:
Diet-1yr back stopped nonveg because doctor told to stop
Decreased appetite
Decreased micturition-since 3-4months
Before 2-3hrs once
Normal bowel movements
Normal sleep
Addictions-kallu,alcohol-occasionally 50ml stopped 2 yrs back
FAMILY HISTORY:-
No significant history
GENERAL EXAMINATION:-
- PALLOR
- NO ICTERUS
- NO CYANOSIS
- NO CLUBBING
- NO KOILONYCHIA
- NO LYMPHADEONAPTHY
- Pedal edema till ankel
SYSTEMIC EXAMINATION:-
A. Cardiovascular system
S1 S2 HEARD
NO MURMURS.
B. Respiratory system
NVBS heard
BAE +
TRACHEA CENTRAL.
C. Per abdominal examination
SOFT
Scaphoid
Mild tenderness on left hypochondrium
D. Central nervous system:-
Conscious
Speech normal
Cranial nerve-NAD
Motor system-
Sensory system-NAD
Cerebellar system-NAD
No signs of meningial irritation/ meningitis
Joint examination
Hands-Swan neck deformity except little finger
Knee-local rise of temperature,crepitus
Elbow-mild rise of temperature,crepitus
INVESTIGATIONS:-
2D ECHO
Day 2
Treatment
TAB OROFER XT PO/OD
TAB LIMCE PO/OD
vitals monitoring
TAB ULTRACET 1/2 tab PO/QID
TAB PREDNISALONE 40mg PO/OD
TAB PAN 40mg PO/OD
For more detail vedios and follow up see these blogs of same patient:-
http://munukutlasaimythili.blogspot.com/2022/09/a-case-of-rheumatoid-arthritis.html
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