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 EXAMINATION;:
Patient is conscious coherent cooperative
Vitals :
BP:128/76 mm hg
PR:78 bpm
RR: 14 cpm
Temperature:afebrile
Pallor :present
Icterus :absent
AA ab da svsdsbddbddddbsdsddvsbsscs DD dbddvqaf DD adqCyanosis :absent
Clubbing :absent
Lymph adenopathy: absent
Paedal oedema : absent
Local examination:
There is swelling and pain and also restricted movements seen in multiple joints :
Both wrists
Distal phalangeal joints of both hands
Both knees
Both ankles
Both elbows
Left shoulder
No local rise of temperature
Soft and non tender
SYSTEMIC EXAMINATION:
Cvs :S1 s2 heard no murmurs
Resp:bilateral normal vesicular breath sounds heard
CNS:
No focal neurological deficits
Provisonal diagnosis :
Rheumatoid arthritis
Investigations :
CBP:
RBS:
Rheumathoid factor:
X- ray
PA view of chest
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