Case
Swelling and pain at hands,feet and elbow

Age: 40
Sex: Female
Race: Caucasian white

History
History of present illness:
A 40 years old female applied to Rheumatology policlinic with a problem of swelling and pain at her hands,feet and elbow and a difficulty at her walking.She has had swelling and pain at her hands and feet for 3 or 4 years.And she doesnt respond to painkillers.She also have morning stiffness more then an hour which cause disability at walk.Also she has nodular swelling at her MCP and DIF joints.

Medical History:
She has Hypertension for 3-4 years.
She has been depressive and taking antidepressans for like 9 years.
She has been smoking for 10 pack year.
She has been told she has glocoma.


Past surgical history:
She had 2 times breast cyst excision operation which had benign results.


Allergies:
Nothing known.

Medications:
Candesartan cylectesil hydrochlorothiazid (for HT)1*1
Atorvastatin 40 mg 1*1
Aspirin 150 mg 1*1
Amlodipin 10 mg 1*1
Ketiapin 200 mg 1*1
Venlafaxin 150 mg 2*1

Family history:
Her mother has DM,HT,Hyperlipidemi

Social history:
She has been depressive and anxious for 9 years


Physical Exam
General:
She looks mild obesis

Heart rate:
120/min.

Blood pressure:
120/80 mm Hg

Respiratory rate:
20/min

Head, ears, eyes, nose & throat:
They all look all alright.

Neck:
Normal

Chest:
normal

Cardiovascular:
Tachychardy

Abdomen:
She has tenderness at her right low quadrant by palpation

GU:
Normal

Rectal:
normal

Neurological:
normal

Skin:
Normal

Laboratories:
ESH:20
WBC:15.500(increased)
Hb:12.2
Htc:36.5
Plt:367,000
MCV:73,8
RF:<20.0

Radiology:
Ýt has been waited for.

Other:
She has tenderness at her MCP,DIF,wrist,elbow by palpation

Plan of treatment:
NSAIDs and a PPI for now.

Discussion:
I beleive she has RA,because of symettric joint inflamation and tenderness.




Comments
The following are comments made by other users of this site and are not in any way an opinion of thirdspace.org or its staff.


jarek1114110/8/2008 - 8:28:52 AM
No evidence of RA.
No evidence of any other form of arthritis.
Plan: X-ray or ultrasound.
If we will have evidence of arthritis start with Methotrexate not with NSAID's

jarek1114110/8/2008 - 8:32:28 AM
No evidence of RA.
No evidence of any other form of arthritis.
Plan: X-ray or ultrasound.
If we will have evidence of arthritis start with Methotrexate not with NSAID's


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