50 F with multiple joint pains and swelling since 5 years

This is an online e log book to discuss our patient de-identified health data shared after taking his / her / guardians signed informed consent. Here we discuss our individual patients problems through series of inputs from available global online community of experts with an aim to solve those patients clinical problem with collective current best evident based input. 

Ch.nagatarun
Date of admission of patient : 11/09/2023
Case:
This is a case of 50 year old female who presented with multiple joint swelling and pain

Chief complaints :
Multiple. Joint pains and swelling 

History of present illness:
Patient was apparantly asymptomatic 5 years ago then she developed swelling in the left knee joint which is insidious in onset gradually progressive it is associated with pain in the knee which was agrravated on walking and doing work and relieved on medication.then she developed pain and  swelling at multiple joints there is an diurnal variation , stiffness is seen on early morning on waking up which gradually decreased by the end of the day .
No history of trauma, fever, rashes, diarrhea jaundice.
History of past illness:
She is not a known case of DM/HTN/TB/ASTHMA 

FAMILY HISTORY 
there are similar complaints with the mother 

PERSONAL HISTORY:
DIET:MIXED
APPETITE :NORMAL 
BOWEL AND BLADDER : REGULAR 
SHE CONSUMES ALCHOL REGULARLY BUT STOPPED CURRENTLY 5 months ago and she smokes beedi regularly .


GENERAL EXAMINATION;:
Patient is conscious coherent cooperative
Vitals :
BP:128/76 mm hg
PR:78 bpm
RR: 14 cpm
Temperature:afebrile

Pallor :present 
Icterus :absent 
AA ab da svsdsbddbddddbsdsddvsbsscs DD dbddvqaf DD adqCyanosis :absent 
Clubbing :absent 
Lymph adenopathy: absent 
Paedal oedema : absent 

Local examination:
There is swelling and pain and also restricted movements seen in multiple joints :
Both wrists
Distal phalangeal joints of both hands
Both knees 
Both ankles
Both elbows 
Left shoulder 

No local rise of temperature
Soft and non tender

SYSTEMIC EXAMINATION:
Cvs :S1 s2 heard no murmurs 
Resp:bilateral normal vesicular breath sounds heard 
CNS:
No focal neurological deficits 




Provisonal diagnosis :
Rheumatoid arthritis

Investigations :
CBP:
impression : normocytic normochromic picture with moderatly anaemic

RBS:
ESR:

Rheumathoid factor: 

X- ray
PA view of chest

Some other clinical images of patient :
ECG report :




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