50y/F with multiple joint pains

THIS IS AN ONLINE E LOG BOOK TO DISCUSS OUR PATIENT'S DE - IDENTIFIED HEALTH DATA SHARED AFTER TAKING HIS / HER /GUARDIAN'S SIGNED INFORMED CONSENT .HERE WE DISCUSS OUR INDIVIDUAL PATIENT'S PROBLEMS THROUGH SERIES OF INPUTS FROM AVAILABLE GLOBAL ONLINE COMMUNITY OF EXPERTS WITH AN AIM TO SOLVE THOSE CLINICAL PROBLEMS WITH COLLECTIVE CURRENT BEST EVIDENCE BASED INPUT     

 

CHEIF COMPLAINTS:

c/o multiple joint pains since 1 year

C/o Neck pain since 1 month

C/o Diminision of vision in both eyes since 6 months 

HOPI:

Patient was apparently asymptomatic 1 year back then she developed pain over the DIP,PIP,MCP, elbow joint,knee joint,ankle joint ,MTP joint

C/o Burning sensation of feet

No c/o SOB , palpitations,chest pain ,orthopnea,PND .

No c/o pain abdomen, fever , burning micturition 

PAST HISTORY:

Not a known case of HTN ,type 2 DM, epilepsy, thyroid disorders, asthma, Tb.

PERSONAL HISTORY: 

Diet - Mixed

Appatite - Normal

Sleep - Normal

Bowel and Bladder -Regular.

Allergy - None

Addictions -None

FAMILY HISTORY: 

No history of similar complaints in the family.

GENERAL EXAMINATION:

The patient is conscious,coherent and cooperative; well oriented to time,place and person.

Pallor - present 

Icterus- absent

Clubbing-absent

Cyanosis-absent

Lymphadenopathy-absent

Edema - absent 

Vitals at the time of admission:

Temperature - 98.6 F.

Pulse rate - 78/ minute 

Respiratory rate - 18/minute

Blood pressure - 100/70 mmHg

SYSTEMIC EXAMINATION:

CVS: 

S1 and S2 heard. 

No addded thrills or murmurs heard

RESPIRATORY SYSTEM:  

Normal vesicular breath sounds heard. 

Bilateral air entry present.

ABDOMEN:

non tender

soft

CNS:

Conscious and coherent.

Normal sensory and motor responses.

INVESTIGATIONS:

TREATMENT:

Tab.Methotrexate 7.5 mg on Sundays (weekly once) 

Tab.folic acid 5mg alternate days po/od

Tab hcq 400mg po/od