This is a case of 50 year old female who presented with multiple joint swelling and pain. Chief complaints : Multiple. Joint pains and swelling History of present illness: Patient was apparantly asymptomatic 5 years ago then she developed swelling in the left knee joint which is insidious in onset gradually progressive it is associated with pain in the knee which was agrravated on walking and doing work and relieved on medication.then she developed pain and swelling at multiple joints there is an diurnal variation , stiffness is seen on early morning on waking up which gradually decreased by the end of the day . No history of trauma, fever, rashes, diarrhea jaundice. History of past illness: She is not a known case of DM/HTN/TB/ASTHMA FAMILY HISTORY there are similar complaints with the mother PERSONAL HISTORY: DIET:MIXED APPETITE :NORMAL BOWEL AND BLADDER : REGULAR SHE CONSUMES ALCHOL REGULARLY BUT STOPPED CURRENTLY 5 months ago and she smokes beedi regularly . GENERAL EXAMI