here i see 4 reasons of joint pain 1.chikungunya..some chikungunya patients have joint pain for years but stiffness of mcp joints and pic rules that out 2.. Urinary tract infection but again ruled out due to above reasons 3. Gout as normal level for females in 5.5 4. Rh.Arthritis seems most apparent diag. Do Anti. ccp an start mefications only after u get reports
Do anti ccp as well as rule out infective arthritis. Urine culture for selecting antibiotics.till you treat symptomatically Ultracet sos for pain vit C 500 mg ; Alkaline agents (Urikind or alkasol)sos.pt to be adv for drinking plenty of water
CLINICALLY IT APPEARS TO BE RA WITH UTI DO ANTI CPP &URINE C&S TEST.TREAT SYMPTOMATICALLY TILL THE REPORT COMES.
raised ESR and CRP :active disease The differential diagnosis includes: viral arthritis (e.g. parvovirus, rubella, hepatitis B) reactive arthritis (e.g. post-infection: throat, gut, sexually acquired) seronegative spondyloarthropathy (e.g. psoriatic, ankylosing spondylitis, Reiter's disease, inflammatory bowel disease) connective tissue disease (e.g. systemic lupus erythematosus, scleroderma) polymyalgia rheumatica polyarticular gout osteoarthritis septic arthritis fibromyalgia medical conditions presenting with arthropathy (e.g. sarcoidosis, thyroid disease, infective endocarditis, haemochromatosis, diabetic cheiroarthropathy, paraneoplastic syndromes, multiple myeloma)
Rheumatoid arthritis, start indomethacin 75mg sr od, tab sallaki 400mg bd for 10 days, do anti ccp, dsdna to confirm RA. Can add amoxicillin potassium clavunate 625 bd, rejoint uc , cap glace x od
प्रथम रोगी का पंचकर्म करें। तत्पश्चात चिकित्सा करें।वातचिंतामणि स्वर्ण युक्त 1 रत्ती। योगेन्द्र रस 1 रत्ती भर शहद मिलाकर सुबह-शाम सेवन कराएं। महारास्नादि क्वाथ को 25 ग्राम सुबह-शाम सेवन कराएं।महानारायण तैल की मालिश करें। निश्चित रूप से लाभ होगा योग परिक्षित है पिछले 40 वर्ष से प्रयोग कर रहा हूं
आयुर्वेद के अनुसार रोगी गठिया से पीड़ित है। चिकित्सा संबंधी योग,,,, छोटी हरड़ को तवे पर देशी घी में भूनकर चबा चबाकर खाएं और फिर ऊपर से ताजा गिलोय का काढ़ा बनाकर पीने को दें। माजून सुरनजान 5 ग्राम माजून फनफसा 5 ग्राम दूध के साथ सुबह शाम सेवन कराएं। चिकित्सा लम्बी चलेगी। निश्चित रूप से लाभ होगा। योग परिक्षित है। पिछले 40 वर्ष से प्रयोग कर रहा हूं।
Clinically, it appears to be a case of Rheumatoid Arthritis, and needs management accordingly.
Sir after doing .anti CCP and ana And doing initial pain management ...put her on ayurvedic medicine .she will definitely improve well... As we can not extend long term treatment with methotrexate, indomethacin and other immunosupprest and dmrd drugs.
Cases that would interest you
- Login to View the image
15 year old boy presents with multiple joint swelling and tenderness for 1 week....the patient currently unable to mobilise.. there is history of on/off joint paints but this event is e worst of all.. patient was born with a missing limb..stays in rural areas...no money for investigations..patient is hiv positive on ART...differentials?Dr. Deepak Raina0 Like7 Answers
- Login to View the image
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 : NHPDr. Hemant Adhikari12 Likes17 Answers
- Login to View the image
Dear Friends, Fever of unknown origin is a very important clinical condition in our day to day practice.. I thought to have an UPDATE on this The subject needs longer discussions.. So will be presented in two parts Let's have the initial one… Fever of unknown origin (FUO) in adults is defined as a (1)Temperature higher than 38.3 C (100.9 F) (2)Lasts for more than three weeks (3)With no obvious source despite appropriate investigations. COMMON ETIOLOGIES OF FEVER OF UNKNOWN ORIGIN.. INFECTIONS Tuberculosis (especially extrapulmonary) Abdominal abscesses Pelvic abscesses Dental abscesses Endocarditis Osteomyelitis Sinusitis Cytomegalovirus Epstein-Barr virus Human immunodeficiency virus Lyme disease Prostatitis Sinusitis MALIGNANCIES Chronic leukemia Lymphoma Metastatic cancers Renal cell carcinoma Colon carcinoma Hepatoma Myelodysplastic syndromes Pancreatic carcinoma Sarcomas AUTOIMMUNE CONDITIONS Adult Still's disease Polymyalgia rheumatica Temporal arteritis Rheumatoid arthritis Rheumatoid fever Inflammatory bowel disease Reiter's syndrome Systemic lupus erythematosus Vasculitides MISCELLANEOUS Complications from cirrhosis Factitious fever Hepatitis (alcoholic, granulomatous, or lupoid) Deep venous thrombosis Sarcoidosis Drug-induced fever DRUGS COMMONLY ASSOCIATED WITH DRUG -INDUCED FEVER.. Allopurinol Captopril Cimetidine Clofibrate Erythromycin Heparin Hydralazine Hydrochlorothiazide Isoniazid Meperidine Methyldopa Nifedipine Nitrofurantoin Penicillin Phenytoin Procainamide Quinidine The approach to diagnose the patient and investigations needed ...will be covered in the second and concluding part if HELPFUL to you Thanks Dr K N PoddarDr. K N Poddar24 Likes20 Answers
- Login to View the image
35 years old female suffering from recurrent painless nonitchy swelling for last 5 years. No h/o respiratory distress. No family history of such lesions. She is a known Hypertensive and for that she is on Telmisertan 40 mg/day. Patient has been treated with Levocetirizine 10mg twice a day for six months and Monteleukast 10 mg at night for six months, but no relief. Only responding to short courses of systematic Steroid 2 mg /kg with tapering dose. 1). Diagnosis 2). D/D 3). Investigations 4). Management. Please give your answers in chronological order.Dr. Sankar Kumar Das9 Likes17 Answers
- Login to View the image
#HolisticMedicine #CCA update Arthritis is very common but is not well understood. Actually, “arthritis” is not a single disease; it is an informal way of referring to joint pain or joint disease. There are more than 100 different types of arthritis and related conditions. People of all ages, sexes and races can and do have arthritis, and it is the leading cause of disability in America. More than 50 million adults and 300,000 children have some type of arthritis. It is most common among women and occurs more frequently as people get older. Common arthritis joint symptoms include swelling, pain, stiffness and decreased range of motion. Symptoms may come and go. They can be mild, moderate or severe. They may stay about the same for years, but may progress or get worse over time. Severe arthritis can result in chronic pain, inability to do daily activities and make it difficult to walk or climb stairs. Arthritis can cause permanent joint changes. These changes may be visible, such as knobby finger joints, but often the damage can only be seen on X-ray. Some types of arthritis also affect the heart, eyes, lungs, kidneys and skin as well as the joints. There are different types of arthritis: Degenerative Arthritis Osteoarthritis is the most common type of arthritis. When the cartilage – the slick, cushioning surface on the ends of bones – wears away, bone rubs against bone, causing pain, swelling and stiffness. Over time, joints can lose strength and pain may become chronic. Risk factors include excess weight, family history, age and previous injury (an anterior cruciate ligament, or ACL, tear, for example). When the joint symptoms of osteoarthritis are mild or moderate, they can be managed by: balancing activity with rest using hot and cold therapies regular physical activity maintaining a healthy weight strengthening the muscles around the joint for added support using assistive devices taking over-the-counter (OTC) pain relievers or anti-inflammatory medicines avoiding excessive repetitive movements If joint symptoms are severe, causing limited mobility and affecting quality of life, some of the above management strategies may be helpful, but joint replacement may be necessary. Osteoarthritis can prevented by staying active, maintaining a healthy weight, and avoiding injury and repetitive movements. Inflammatory Arthritis A healthy immune system is protective. It generates internal inflammation to get rid of infection and prevent disease. But the immune system can go awry, mistakenly attacking the joints with uncontrolled inflammation, potentially causing joint erosion and may damage internal organs, eyes and other parts of the body. Rheumatoid arthritis and psoriatic arthritis are examples of inflammatory arthritis. Researchers believe that a combination of genetics and environmental factors can trigger autoimmunity. Smoking is an example of an environmental risk factor that can trigger rheumatoid arthritis in people with certain genes. With autoimmune and inflammatory types of arthritis, early diagnosis and aggressive treatment is critical. Slowing disease activity can help minimize or even prevent permanent joint damage. Remission is the goal and may be achieved through the use of one or more medications known as disease-modifying antirheumatic drugs (DMARDs). The goal of treatment is to reduce pain, improve function, and prevent further joint damage. Infectious Arthritis A bacterium, virus or fungus can enter the joint and trigger inflammation. Examples of organisms that can infect joints are salmonella and shigella (food poisoning or contamination), chlamydia and gonorrhea (sexually transmitted diseases) and hepatitis C (a blood-to-blood infection, often through shared needles or transfusions). In many cases, timely treatment with antibiotics may clear the joint infection, but sometimes the arthritis becomes chronic. Metabolic Arthritis Uric acid is formed as the body breaks down purines, a substance found in human cells and in many foods. Some people have high levels of uric acid because they naturally produce more than is needed or the body can’t get rid of the uric acid quickly enough. In some people the uric acid builds up and forms needle-like crystals in the joint, resulting in sudden spikes of extreme joint pain, or a gout attack. Gout can come and go in episodes or, if uric acid levels aren’t reduced, it can become chronic, causing ongoing pain and disability. Diagnosing Arthritis Arthritis diagnosis often begins with a primary care physician, who performs a physical exam and may do blood tests and imaging scans to help determine the type of arthritis. An arthritis specialist, or rheumatologist, should be involved if the diagnosis is uncertain or if the arthritis may be inflammatory. Rheumatologists typically manage ongoing treatment for inflammatory arthritis, gout and other complicated cases. Orthopaedic surgeons do joint surgery, including joint replacements. When the arthritis affects other body systems or parts, other specialists, such as ophthalmologists, dermatologists or dentists, may also be included in the health care team.Dr. Rina Upadhyay17 Likes26 Answers