A CASE OF ARTHRITIS

This is an online e log book to discuss our patient’s de- identified health data shared after taking his/her/guardian’s signed informed consent. Here we discuss our individual patient’s problems through series of inputs from available global online community of experts with an aim to solve those patient’s clinical problems with collective current best evidence based inputs. This e-log book reflects my patient centered online portfolio and your valuable inputs on the comments is welcome.”

A 45 year old gentlemen who was a farmer from suryapet came to the hospital with chief complaint of

Cheif complaint
Decrease in micturation since 1 wee
Joint pain since 1 week
Right sided lower abdominal pain  since 10 days

History of presenting illness
Patient was apparently asymptomatic 2 years back↓

 Then he developed pain in right knee which was insidious in onset  gradually progressing nonradiating dull in nature
⬇️
Pain was not aggravated while sitting or bending
⬇️
After 1 month there was decrease in left knee pain and then left  ankle started to pain
There was pain left elbow joint followed by left wrist joint .. And then involvement of after another each joint pain used to last for 10 -14days 
⬇️
There was involvement of following joints
Knee 
ankle
Shoulder
Elbow
Wrist
There was no involvement of proximal and distal interpharengeal joints
No involvement of back or neck
⬇️
He visited a rmp after 3 months where he was given medication? 
Took one per day when it hurts
⬇️
There was no time when all joints were involved
1 year back he visited our hospital with regarding  pain since 1 week which was  for which he was admitted for 5-6 days 
He used medication for a month and the pain subsided 
⬇️
gradually and increased by 6 months
He also stopped going to work when he was admitted and has not gone since
⬇️
There are also white patches on fore head going into the hair since 4 years
⬇️
There is also decreased frequency of micturation since 3-4 months


Past history

N/k/c 
Diabetes
Hypertension
Tuberculosis
Asthama

Daily routine
 2 yrs back -
 
 wake up at 4-5am
 Eat rice 
 11am-12pm - work
 2-3pm lunch box at work
 8-9pm come back to home 
 Dinner-9pm
 Watch tv 
 9:30-10pm- sleep


1yr back-

Wake up at 7am
Drink plain milk
Takes rest
9:30-10am- rice( less than before)
Time pads
2-3pm-lunch
Sleep
4-5wake up
Time pass
8pm-dinner
Sleep

PERSONAL HISTORY:
Diet-1yr back stopped nonveg because doctor told to stop
Decreased appetite
Decreased micturition-since 3-4months 
Before 2-3hrs once 
Normal bowel movements
Normal sleep
Addictions-kallu,alcohol-occasionally 50ml stopped 2 yrs back


FAMILY HISTORY:-
No significant history

Provisional diagnosis
Anemia 2 to vit B12deficiency
Seronegative? RA
Osteoarthritis 
Chronic kidney disease
Cholelithiasis

GENERAL EXAMINATION:-

Vitals:-
Temp- afebrile
PR:91BPM.
Bp:100/80mm Hg
Spo2 : 100%
GRBS: 84 MG%


PALLOR present

No ICTERUS
NO CYANOSIS
NO CLUBBING
NO KOILONYCHIA 
NO LYMPHADEONAPTHY
EDEMA present pitting type till ankle



SYSTEMIC EXAMINATION:-

A. Cardiovascular system 
S1 S2 HEARD
NO MURMURS.
B. Respiratory system 
NVBS heard
BAE +
TRACHEA CENTRAL.


C. Per abdominal examination 
SOFT
Scaphoid
Spleenomegaly
Mild tenderness on left hypochondrium
D. Central nervous system:-
Conscious 
Speech normal
Cranial nerve-NAD
Sensory system-NAD
Cerebellar system-NAD
No signs of meningial irritation/ meningitis




Joints

Joint examination
Hands-Swan neck deformity except little finger
Knee-local rise of temperature,crepitus
Elbow-mild rise of temperature,crepitus





Investigation

Day 1

Day 2






FNAC PROCEDURE FNAC












Treatment
TAB OROFER XT PO/OD
TAB LIMCE PO/OD
vitals monitoring
TAB ULTRACET 1/2 tab PO/QID
TAB PREDNISALONE 40mg PO/OD
TAB PAN 40mg PO/OD
Day 2
TAB OROFER XT PO/OD
TAB LIMCE PO/OD
vitals monitoring
TAB ULTRACET 1/2 tab PO/QID
TAB PREDNISALONE 40mg PO/OD
TAB PAN 40mg PO/OD
 TAB METHOTREXATE 7.5 mg/PO/WEEKLY ONCE
TAB FOLIC ACID EVERY ALTERNATIVE DAY

DAY 3
TAB LIMCE PO/OD
vitals monitoring
TAB ULTRACET 1/2 tab PO/QID
TAB PREDNISALONE 40mg PO/OD
TAB METHOTREXATE 7.5 mg/PO/WEEKLY ONCE
TAB FOLIC ACID EVERY ALTERNATIVE DAY
Syrup CREMAFFIN 15 ml /PO/HS
INJ METHYLCOBALAMINE 1500micrograms/IV/30MIN IN 100ml
TAB F6BUXO STAT 40 mgPO/OD

DAY 4
TAB LIMCE PO/OD
vitals monitoring
TAB ULTRACET 1/2 tab PO/QID
TAB PREDNISALONE 40mg PO/OD
TAB METHOTREXATE 7.5 mg/PO/WEEKLY ONCE
TAB FOLIC ACID EVERY ALTERNATIVE DAY
Syrup CREMAFFIN 15 ml /PO/HS
INJ METHYLCOBALAMINE 1500micrograms/IV/30MIN IN 100ml
TAB F6BUXO STAT 40 mgPO/OD

Day 5
TAB LIMCE PO/OD
vitals monitoring
TAB ULTRACET 1/2 tab PO/QID
TAB PREDNISOLONE 10mg PO/OD
TAB METHOTREXATE 7.5 mg/PO/WEEKLY ONCE
TAB FOLIC ACID EVERY ALTERNATIVE DAY
Syrup CREMAFFIN 15 ml /PO/HS
INJ METHYLCOBALAMINE 1500micrograms/IV/30MIN IN 100ml
TAB F6BUXO STAT 40 mgPO/OD
TAB PAN 40mg PO/OD

Day 6
TAB LIMCE PO/OD
vitals monitoring
TAB ULTRACET 1/2 tab PO/QID
TAB PREDNISOLONE 10mg PO/OD
TAB METHOTREXATE 7.5 mg/PO/WEEKLY ONCE
TAB FOLIC ACID EVERY ALTERNATIVE DAY
Syrup CREMAFFIN 15 ml /PO/HS
INJ METHYLCOBALAMINE 1500micrograms/IV/30MIN IN 100ml
TAB F6BUXO STAT 40 mgPO/OD
TAB PAN 40mg PO/OD

Day 7
TAB LIMCE PO/OD
vitals monitoring
TAB ULTRACET 1/2 tab PO/QID
TAB PREDNISOLONE 10mg PO/OD
TAB METHOTREXATE 7.5 mg/PO/WEEKLY ONCE
TAB FOLIC ACID EVERY ALTERNATIVE DAY
Syrup CREMAFFIN 15 ml /PO/HS
INJ METHYLCOBALAMINE 1500micrograms/IV/30MIN IN 100ml
TAB F6BUXO STAT 40 mgPO/OD
TAB PAN 40mg PO/OD

Day 8
TAB LIMCE PO/OD
vitals monitoring
TAB ULTRACET 1/2 tab PO/QID
TAB PREDNISOLONE 10mg PO/OD
TAB METHOTREXATE 7.5 mg/PO/WEEKLY ONCE
TAB FOLIC ACID EVERY ALTERNATIVE DAY
Syrup CREMAFFIN 15 ml /PO/HS
INJ METHYLCOBALAMINE 1500micrograms/IV/30MIN IN 100ml
TAB F6BUXO STAT 40 mgPO/OD
TAB PAN 40mg PO/OD


Day 9
TAB LIMCE PO/OD
vitals monitoring
TAB ULTRACET 1/2 tab PO/QID
TAB PREDNISOLONE 10mg PO/OD
TAB METHOTREXATE 7.5 mg/PO/WEEKLY ONCE
TAB FOLIC ACID EVERY ALTERNATIVE DAY
Syrup CREMAFFIN 15 ml /PO/HS
INJ METHYLCOBALAMINE 1500micrograms/IV/30MIN IN 100ml
TAB F6BUXO STAT 40 mgPO/OD
TAB PAN 40mg PO/OD
TAB DOLO650 mg/PO/TID
TAB MONOCEF 1gm/IV/BD



Day 10
TAB LIMCE PO/OD
vitals monitoring
TAB ULTRACET 1/2 tab PO/QID
TAB PREDNISOLONE 10mg PO/OD
TAB METHOTREXATE 7.5 mg/PO/WEEKLY ONCE
TAB FOLIC ACID EVERY ALTERNATIVE DAY
Syrup CREMAFFIN 15 ml /PO/HS
INJ METHYLCOBALAMINE 1500micrograms/IV/30MIN IN 100ml
TAB F6BUXO STAT 40 mgPO/OD
TAB PAN 40mg PO/OD
TAB DOLO650 mg/PO/TID
TAB MONOCEF 1gm/IV/BD


Day 11
TAB LIMCE PO/OD
vitals monitoring
TAB ULTRACET 1/2 tab PO/QID
TAB PREDNISOLONE 10mg PO/OD
TAB METHOTREXATE 7.5 mg/PO/WEEKLY ONCE
TAB FOLIC ACID EVERY ALTERNATIVE DAY
Syrup CREMAFFIN 15 ml /PO/HS
INJ METHYLCOBALAMINE 1500micrograms/IV/30MIN IN 100ml
TAB F6BUXO STAT 40 mgPO/OD
TAB PAN 40mg PO/OD
TAB DOLO650 mg/PO/TID
TAB MONOCEF 1gm/IV/BD

Day 12


COURSE IN HOSPITAL
SOAP NOTES
DAY 1



DAY 2


DAY 3


DAY 4

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