34 year old female with generalised body pains

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Patient came to casuality with chief complaints of

- generalised body pains since 4 months 

a/w pedal edema since 1month

a/w fever 

HOPI: 

Patient was apparently asymptomatic 4 months back then she developed severe joint pains involving toes and fingers not a/w swelling slowly progressing to involve other joints , wrist, elbow, shoulder,knee, and ankle

- pain a/w restriction of movement since 3 months

- stiffness of joints present since 3 months , aggrevated with increased activity 

-stiffness and pain are more in the morning ( after waking up ) and decreasing as the day progressed ( increased again at the night after 7.30pm ) disturbing her sleep quality 

-swelling joints present at the knee and MCP joints since 4 days ( on and off) resolves spontaneously 

-swelling at ankle : Non pitting type , increased when standing and working and decreased at rest

- pt c/o decreased capacity to work due to pain since 4 months 

-No similar complaints in past

-N/K/C/O  DM,HTN,CAD,Asthma,TB,epilepsy 

H/o similar complaints in the family( sister and father) 

VITALS:

temp: afebrile  

Pr : 88/min

Rr: 12/min

Bp : 80/60 mmhg

Spo2 : 99% @ra

S/E:

CVS: S1S2 +

RS: BAE +

P/A : soft, non tender

CNS: NAD

PROVISIONAL DIAGNOSIS: RHEUMATOID ARTHRITIS 

TREATMENT GIVEN:

1) TAB.NAPROXEN 250MG/PO/TID

2)TAB.PAN 40MG PO OD 

3)TAB.WYSOLONE 10MG PO BD

4)TAB.METHOTREXATE 7.5mg PO OD WEEKLY ONCE (WEDNESDAY)

5)TAB.FOLIC ACID 5MG PO OD WEEKLY ONCE (THURSDAY)