38 year old female with diffuse headache and multiple joint pains

A 38 year old female sales person by occupation came with complaints of

Diffuse headache since 1 year

Multiple joint pains since 1 year

Lumbar-cervical-shoulder joint-knee joint-wrist-PIP

DIP -spared

HOPI

Patient was apparently asymptomatic 1 year back then developed headache -diffuse type,insidious in onset ,gradually progressive

Relieved on medication

Multiple joint painsnot associated with early morning stiffness and fever.joint pains increases with work associated with neck pain

Tingling of both upper limbs

Past history

K/C/O HTN -not on medication

N/K/C/O DM,BA,EPILEPSY, TB

GENERAL EXAMINATION -

Patient is Conscious, coherent,co operative well oriented to time,place,person

pallor-+

No icterus, No Cyanosis, No lymphadenopathy, No edema

VITALS-

Temperature -98.6F

Pulse rate- 84bpm

Blood pressure-120/90mm hg

Respiratory rate -16cpm

SYSTEMATIC EXAMINATION:

CARDIOVASCULAR SYSTEM:

S1,S2 heard, NO Murmurs

RESPIRATORY SYSTEM:

BAE present,NVBS

CENTRAL NERVOUS SYSTEM:

NAD

PER ABDOMEN:Soft, non tender

No guarding, No rigidity

Bowel sounds present

INVESTIGATIONS-

USG abdomen - grade 1 fatty liver

ESR-

27/4/22-60 mm/1st hour

4/5/22-50mm/1st hour

RA factor -negative

CRP-negative

ANA-negative

CBP-

Hb-13.1gm/dl,TLC-8000cells/cumm,plt-2.56lakhs/cumm

TB-0.65mg/dl

DB-0.24mg/dl

DIAGNOSIS-

?RHEUMATOID ARTHRITIS

Treatment-

1.Tab AMITRIPTYLINE 10mg 1/2 tab /PO/HS

Comments

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This is an online e logbook to discuss our patients deidentified health data shared after taking her/guardian's signed informed consent Here we discuss our individual patient problems through series of inputs from available global online community of experts with an aim to solve those patients clinical problems with collective current best evidence based inputs This E log also reflects my patient centre’s online learning portfolio and valuable inputs on the comment box is welcome. A 45 year old gentlemen ,from ramanapet who is farmer by occupation came to the OPD with CHIEF COMPLAINTS: B/l Pedal edema since 3 months Shortness of breath since 2 months HISTORY OF PRESENT ILLNESS: Patient was apparently asymptomatic 3 months back then developed pedal edema, insidious in onset, bilateral ,gradually progressive from involving ankles to limbs (grade1to grade 3 ), pitting type ,aggravated by walking and by end of the day,relieved by elevating leg, then developed shortness of breath w

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