Joint pain ankle bilateral
Loss of appetite since 2 wks
On off Rise BP

Question

Female patient age 32
Weight 64kg

*Chief Complaints*
Joint pain
Weakness

*History*
She is athelete and doing gym on daily basis but stop due to pain

*Vitals*
Bp:140/84
Pulse:85
Spo2 92

*Physical Examination*
On examination mild swelling around heel

*Investigations*
Cbc: Esr 34
Ra factor 16.2 positive

Xray Ankle NAD

*Diagnosis*
RA??

*Management*
I prescribe Tab:Deflazakort 6 mg bd
                    Tab:Rutoheal one Bd
                    Tab: Aceclofenac 100 mg bd
                    Tab:Shelcal d3 one od with milk 
All above med for one week patient feel relief but she is anxious about health

What I can do for follow up

Riju N · Answer

Sounds like inflammatory arthritis 
You brought Remission with anti inflammatory medicines 
Now she need long term treatment to prevent Relapse 
Better do it in consultation with a Rheumatologist 
Rule out other medical conditions that can mimic inflammatory arthritis

Krishnan Pichumani · Answer

Suggest 
CRP  , Anti cyclic Citrulinated protein ( ACCP ) , ANA  ( to rule out SLE ) 
Ultrasound exam of ankle joint to confirm synovial thickening and joint effusion. 
Follow with DMARD  like HCQ, sulphosalicylic acid , methotrexate etc. 
Steroid can be tapered off. 
Vit D and calcium supplements.  
Rest , physiotherapy,

Rafat Ali · Answer

Tab:adenomac 400 od for 7 days

Joint pain ankle bilateral Loss of appetite since 2 wks On off Rise BP

Agree

Disagree

1

Thank you doctor

Agree

Disagree

2

Thanks sir

Agree

Disagree

1

Thank you doctor

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