Short. Case

 Short case

50 year old female came to the OPD with the chief complaints of pain and stiffness in several joints since 2 months

HISTORY OF PRESENT ILLNESS :

She was apparently asymptomatic 10 years ago, then she developed a dull aching type of pain and stiffness in her joints of the fingers (MCP joints) of right hand with limitation of movements at the joints. 

Then within 5 months of onset of the disease, it progressed to involve other joints of the right hand and left hand as well ( wrist joint and elbow joint ) 

Within 5 years of onset she started feeling pain in the joints of the feet and ankle. 

Since 2 months the pain became unbearable limiting her activities. 

The pain was insidious in onset, slowly progressive dull aching type of pain, non radiating, associated with swelling, stiffness and limitations of movements in the involved joints.

Stiffness and pain was more in the first 1 hour of waking up and gradually improved on movement.

There are few exacerbations associated with fever.

No deformities 

No loss of weight

LOCAL EXAMINATION :

INSPECTION :

Skin : 

No pigmentation 

No scars 

No atrophic changes 

Nails: normal 

Soft tissues: swelling over the joints 

Deformities : no deformities 

                                   

PALPATION :

Skin: warm

Sensations are preserved 

Soft tissues: no edema 

Joint : mild swelling over the joint 

Tenderness over the joint (squeeze test)

Movements:

Decreased range of movements at PIP, MCP, wrist, elbow, ankle joints 

All active and passive movements at the involved joints and painful.

INVESTIGATIONS:

1. ESR 

2. CRP

3. Rheumatoid factor 

         

                  

4. Antibodies 

5. X-ray 

PROVISIONAL DIAGNOSIS:

                                                

ACTIVE RHEUMATOID ARTHRITIS