middle aged women with c/o poly artheralgia for 3to4years weakness feeling like feverish dysponea or breathlessness on exertion. also c/o frequent motions in a day for more than 6 months but not loose rather semisolid in consistency. o/e afebrile pulse 74/ mt bp120/80 non diabetic bsl f 97 pp 103 hba1c6.3% eag136 vit d 5.03 ng tft normal 3 samples of stool normal study no occult blood and insignificant. her crp is 3.83 negative and Aso titre is negative but RA F IS 86.6% urine is nad no signs of sle.open for discussion.xray chest is wnl.

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Polyarthralgia,chronic diarrhoea.suggestive of autoimmune disease,tongue and nails suggestive of anemia (iron,B12defeciency).vit D deficiency also noted.RA positive so go for anti CCP Do ANA test to rule out mixed connective tissue disorder, Chronic diarrhoea(IBD or ibs ) needs further evaluation to club with main disease

Thanx sir
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It looks like a case of ulcerative collitis Do colonoscopy,and poly arthralgia may be due to that,and weakness. Once diagnosis confirmed,still do investigation for arthritis. Have you taken her temperature. If no collitis think Of TB .

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I will advise ANA profile and anti CCP antibody in this pt. And if they will come negative than go for ANCA study

Adv ANA & Anti RNP x-ray hands & feet look like scleroderma + RA suggest MCTD.also get her HIV done.

Clinical examination of tounge palpation.have constitutional test for scleroderma

Anti ccp should be done.any significant history or clinical finding?

RA is strong positive and pain deformity of small joints is evident beside anaemia.what more is needed and anti ccp is necessary in this case how it will help in treatment.
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Thanx to all colleagues for wise guidence

Frequent motions can be caused by use of NSAIDs or mesoprostol and dyspnea, breathlessness can be due to lung causes like asthma most probably. Ayurvedic Rx -yograj guggul, gokshuradi guggul, shring bhasm, malasindur (in very very low dose), giloy Satva with ginger juice and honey BD alongwith Rasnaerandadi kashayam. ajmodadi churna for digestion Then after aampachan, basti with dashmool kwath and panchguna oil/ saindhavadi oil for external use for pain. Heavy food, fatty food should be strictly avoided.

This patient with polyarthralgia and multiple deformities (which are not visible) and Anemia which is not evident as there is no visible pallor...RA Factor is false positive in a large number of conditions...VitD def can explain many symptoms of this patient alone...Diarrhoea needs to be evaluated...Do screening with ANA and IBD is unlikely as CRP is negative ...Do all routine investigations and proceed in a step by step diagnostic manner....

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