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..


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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

Yes u r right...she just needa to resuce weight in that area

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

Check out h/o HTN as some anti hypertensive drugs also cause pedal edema

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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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