37year old female with ?Rheumatoid arthritis

History taken by 

Dr.Sai charan

Dr.chandana

37year old female ,married in 2003,child birth in 2005,full term normal vaginal delivery and after 8months of NVD in 2006 pt developed low back ache and was diagnosed with potts spine(bone TB) ,pt was on complete bed rest(?paraperesis) for 11months

and used ATT for 12months and was told to be cured of potts spine completely after 12months of ATT

2008 pt had c/o peeling of skin from ear lobules,weight gain,moon like face,irregular menstruation,hair fall and infertility

For infertility pt used govt pills after which she had more weight gain and later was diagnosed to be hypothyroid( TSH around 13)and was started on 50mcg intially ,later 75mcg,100mcg and since 2016 she is on thyronorm 125mcg OD(Latest TSH report available -dec 2020 TSH :2.24)

2010-2011 pt started to develop B/L knee pains(left>right),and progressed to B/L shoulder,wrist and later small joints,elbow

She reports classical morning stiffness of about 30mins everytime she sleeps and wakes up.Even when she takes a nap in the afternoon pt develops stiffness of all joints after waking up, which lasts for 15-30mins,which later decreases on doing work 

As the pains were not subsiding in 2014 pt visited hospital and got some investigations done,which showed,

2014:CRP positive,RA factor negative,anti CCP negative,ANA screening POSITIVE,,Anti Ds DNA negative

used medications

2016: CRP positive,RA factor positive,anti ccp negative

pt was started on Tab sulfasalazine 1gm PO BD

and was fine for about 3years pertaining to joint pains

2017: pt had episodes of giddiness, palpitations aggrevated on climbing stairs,excessive sweating ,no c/o chest pain for which she visited hospital and was diagnosed to be hypertensive and was started on Losar-H 1 tab ,but pt was taking half tab

Now pt started developing severe joint pains again which are not being subsided with sulfasalazine,and now is prescribed on Telemedicine with Tab.wysolone 10mg,Tab naproxen 250mg TID.(using since 10days)

Personal history :pt is a tobacco chewer since 5years, alcoholic since 5years weekly 3-4 times ,whiskey 90-180ml everytime

Family history:Paternal grandmother and her fathers sister both have arthritis similar to the pt.Pts mother has hypertension.

O/E 

Pt c/c 

Bp 140/100

PR 86bpm

RR 17cpm

Grbs 131mg/dl

Pt obese

Moon like face +

? Rash over malar region+

Cvs s1s2+,no mumurs

RS BaE+,NVBS

P/A soft,Non tender,no organomegaly

Wrist joint : restriction of movement+,no tenderness,no deformities

Ankle joint: restriction of movement+,no tenderness,no deformities.

Elbow, shoulder,small joints of hands and toes:no restriction of Movement,no tenderness,no deformities