50 Y/O Female,post menopausal. Pain in Rt knee with swelling in medial side since 6 months(now pain more). Pain and swelling in left knee in medial side since 1 month. Swelling is warm, slight tender on palpation,soft,non mobile and belt like shspe. Multiple petechiae spots around joints. No history of trauma,past infections in recent past. Has slight persistent fever. RF -ve, antiCCP -ve, X ray WNL. No improvement on HCQ & Methotrexate(discontinued both last wk). Pt is currently on Etoricoxib. Plz suggest diagnosis & possible workup.

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The swelling is fat deposition Pain is due to OA it radiate to the area of swelling There is varus both knee This is different from RA for which she was taking treatment This is age related Sometimes secondary OA in a preexisting RA get both knee AP in standing position Take a routine lateral view Analgesics Calcium vitD Physiotherapy Post the xrays Repeat CBC ESR LFT RFT Bleeding time Clotting time This is needed in RA cases on long term treatment.
Post menopausal must be associated with OA. But X-ray knee is normal, clinically there is effusion,may be bursitis. Investigation: Vitamin D3 assay, Calcium level,FSH,MRI of knee. Advice: Quadriceps exercise, Ice-cold compression. Treatment: Vitamin D3 60k once in a week,Tab Calcium 500mg HS,Tab Glucosamine Diacerein BD,Tab Serratiopeptadase 15mg BD. Consult with Orthopaedic Surgeon.
Thank you doctor.
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When all relavant investigations are NAD A synovial Biopsy after arthroscopy .
Swelling is warm, and multiple Pete chase spots around knee.. Lab reports given are not reflecting Platelet levels... Kindly get that done,.. Rule out other causes of possible B/L haemarthrosis like acquired hemophilia or history of anticoagulants etc.. Rule out SLE.. ESR is high... MRI and aseptic diagnostic aspiration of the synovial fluid will help
VERICOSE VEINS ARE SEEN IN BELT SHAPED AREA VERICOSE VEINS ARE ALSO SEEN OVER THIGHS THROMBPPHILITIS IS A POSSIBLITY MENOPAUSAL WOMAN. ANY HRT ? BLOOD URIC ACID , CRP , SUGAR CBC RX PARACITAMOL ANTIBIOTIC IF INFECTIVE ETIOLOGY
X-Ray knee AP Lateral midflexion .Serum Uric acid . Blood sugar profile . Treatment- a course of NSAID , SWD with IFC . When pain free Quadriceps exercises. Knee braces .
Check for patella tap effect of over weight and OA knees requires rest analgesics no squatting and quadriceps exercise
Knee joint effusion to be ruled out 2 2nd possibility bursitis MRI OF knee Rest.antibiotics.antiinflammatory.analgesics
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