Rheumatoid arthritis

Rheumatoid Arthritis under Ix with UTI? Chief Complaints A 50 yr old female has come with pain in multiple joints for past 14 yrs. There is also associated alopecia and recurrent mouth ulcer. Pt is also suffering from depressive illness. No H/O HTN, T2DM, Thyroid Disorder, Substance abuse. Normal Menstrual cycle. O/E symmetric small joints of small hand, wrist, knee joint and ankle are involved without any visible deformity. Pt has pallor.. Rest findings are normal. Routine Ix along with ESR, CRP, RA factor, Xray of chest, digits and knee jt was done. Also Routine Urine examination. Reports have shown positive RA factor, raised ESR, low Hb, pus cells and hematuria in urine and juxta articular osteopenia and cavity of digits. As per ACR -EULAR criteria pt fits the Dx of Rheumatoid arthritis. Will send sample for anti ccp. Has admitted the pt and started symptomatic management. Also sent sample for Urine C/S, USG W/A, 24 hr urinary protein etc.

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A female patient with polyarticular arthritis, oral ulcers, alopecia, raised ESR, but negative CRP, Urine showing RBCs. Please also send ANA by IF method (in addition to Anti-CCP) as she could be having connective tissue disease instead of RA. A rheumatologist should be involved in the care of such patients.

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