42 yr female comes with swelling on both ankles since from last one year.in investigation uric acid,rft,lft,cbc all r in normal range.in treatment give lyser d tds nd b complex nd in between light steroid also added..but does not improved. .give the right advise
Why steroids??? please don't add steroid to every patient blindly...these r lethal drugs...first u didn't check her thyroid levels... hypothyroidism is a cause for bilateral edema..Get an Echo done to rule out cardiac failure.Get total serum protein estimation to rule out hypoproteinemia.Then local cause of edema is dilated veins..get a colour Doppler done...Sometimes it is idiopathic cause also especially in middle aged females.. due to lymphatic insufficiency.. in that case limb elevation with elastic stockings can be prescribed.Steroids can themselves cause edema so stay clear from them..
hello dr.. first of all there is no indication for diclofenac and steroids unless it is rheumatoid or osteoarthritis related problem.. If it is not a joint problem than the edema will worsen with nsaid and steroids. if the pt is hypertensive and taking amlodipine change it to different class of anti-htn drugs. If she is not on amlodipine than do tsh to rule out hypothyroidism. and urine examination to look for proteinuria.. if all reports are normal, and swelling is associated with pain do crp and RF. if all work up is negative than just give a small dose of diuretics than the edema will subside..
I think patient is overweight which causes achilies tendenopathy Need to icing,ultrasound and heel silicon cushion
Idiopathic ... Is it persistent or intermittent ? Any relation with menses ? If blood workout and urine is normal with no cardiac morbidity I will consider this as vascular .. Lifestyle modification , anti gravity position of the limbs ... Just want to add a relevant info ... In case of gout, hypouricemic treatment is given only if documented 2 episodes of acute hour in one calendar year .... That means if asymptomatic and high Uric acid then go for diet modification
Rule out hypertension and amlodipine intake. If it's just b/l ankle edema can be a case oligoarthritis-in such scenario intermittent steroids won't work ,you need to give regular steroids in adequate dose at least for 6 to 8 weeks before tapering.Aspirin r paracetamol is a better option for symptomatic pain relief avoid diclofenac which itself can cause edema.Have you checked her RA factor n CRP status?
Need to rule out hypothyroidism, hypoalbunaemia, filariasis, cardiac failure, tumors in the lower abdomen and cirrhosis of liver.TFT, COLOR DOPPLER, COMPLETE HEMOGRAM, USG Abdomen and pelvis, ECG, se creatinine & BUN could be done to rule out the DD one by one.
Two major dx can be gout/kidney dysfunction and vericose veins if RFT is normal then go for vericose vein Colour Doppler B/L lower limbs can be done
Is the ESR level normal ? Looks like synovitis or peroneal tendinopathy. Also do a rheumatoid profile
Dont give her any medicines...just tell her to reduce weight ..it will be fine..
Rule out Hypertension - electrolyte imbalance, can also check TSH
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pls suggest diagnosis age 60 yrs male pt.having swelling in lt knee joint
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World Arthritis Day 2018 World Arthritis Day (WAD) was established in 1996 by Arthritis and Rheumatism International (ARI) to raise awareness of issues affecting people with rheumatic and musculoskeletal diseases (RMDs). It is celebrated every year on 12th October. 'Don't Delay, Connect Today' theme initiated in 2017 by the European League Against Rheumatism (EULAR) continues to give importance on early diagnosis and access to care in 2018. ‘Don’t Delay, Connect Today’ campaign calls on people including the public, physicians, health professionals and policy-makers to connect early for earlier diagnosis of RMDs and timely access to evidence-based treatment. The overall goal is to highlight RMDs as major public health problem globally and that early diagnosis and timely access to treatment can prevent further damage and burden on the individual and society. Why is early diagnosis important? Early diagnosis is important to prevent further damage, if not treated early daily activities are affected, reducing the quality of peoples' life and affecting physical abilities. Delay is often due to a lack of awareness hence it’s important to know the symptoms of RMDs and consult a healthcare professional early. RMDs are commonly divided into inflammatory and non-inflammatory types: Common non-inflammatory RMDs are degenerative spine diseases, osteoarthritis, osteoporosis and fibromyalgia Common inflammatory RMDs are rheumatoid arthritis, ankylosing spondylitis, reactive arthritis, connective tissue diseases and polymyalgia rheumatica. RMDs can be hereditary; can also be triggered by lifestyle factors such as smoking, excessive weight, sedentary lifestyles, increasing age and having occupations that lead to injury and overuse of joints/muscles; however, in some cases the causes are unknown. Early medical treatment of inflammatory RMDs, particularly in the first 12 weeks, can prevent joint and organ damage and improve long-term function. What is Arthritis? The word arthritis actually means joint inflammation; in public health arthritis is used as a shorthand term for arthritis and other rheumatic conditions. What are the most common types of arthritis? The most common forms of arthritis are osteoarthritis, gout, fibromyalgia, and rheumatoid arthritis. What are the symptoms of arthritis? Symptoms of arthritis in affected joint are- swelling, pain, stiffness, decreased range of movements. How does body weight influence arthritis? Maintaining a healthy weight reduces the risk of developing osteoarthritis. Health tips for living with RMDs/Arthritis- (a)Healthy living- Improve your wellbeing by keeping high on emotional wellbeing, self-management and motivation and by making healthy life style choices such as: Don't smoke. Avoid stress- As stress can alter behaviour, affect sleep patterns, change appetite and increase muscle tension therefore use relaxation techniques to help manage stress. Get adequate sleep- Get enough quality sleep to protect your mental and physical wellbeing and quality of life. Reduce alcohol intake (b) Healthy eating- Healthy and balanced diet is important for people with rheumatic and musculoskeletal diseases (RMDs). Control your salt and sugar intake: Try to reduce sugar intake as it is high in calories especially in soft drinks, ready meals and confectionery foods. Salt intake should be less than 5 grams per day for adults. Too much salt can cause high blood pressure, an increased risk of heart disease and osteoporosis. (c) Physical activity and fitness- Being physically active is good for general health and can have specific benefits for people with RMD/Arthritis. Consult your doctor or physiotherapist about the type of exercise most appropriate for your condition. Exercise may be in the form of cycling, dancing, walking, gardening, swimming, yoga etc. Source : NHP
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pls suggest diagnosis male pt age 60 yrs having swelling in lt knee joint
Dr. Amishi Sanghvi3 Likes24 Answers - Login to View the image
A 56-year-old woman was presented with a 3-day history of gradually worsening pain and swelling in her left knee. She denies injury, fever, or other complaints. She has never experienced this type of pain before, and she states that she is fairly active.
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