Pt. 53/F, C/O pain n jt stiffness in B/L hands n feet since 7-8 yrs. H/O chicken gunia fever 7-8 yrs ago. O/e, stiffness of MCP pIP n dIP jts of both hands. Ankle n MTP jts stiffness. Clinical pic n ixns attached. Advise, Dx n rx plz.

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CLINICALLY IT APPEARS TO BE RA WITH UTI DO ANTI CPP &URINE C&S TEST.TREAT SYMPTOMATICALLY TILL THE REPORT COMES.

Thank u sir
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RA...Reiter...

Clinically, it appears to be a case of Rheumatoid Arthritis, and needs management accordingly.

RA, Gout,UTI? Immunosuppresent, Corticosteroid, NSAID, Xylloric, Antibiotic

here i see 4 reasons of joint pain 1.chikungunya..some chikungunya patients have joint pain for years but stiffness of mcp joints and pic rules that out 2.. Urinary tract infection but again ruled out due to above reasons 3. Gout as normal level for females in 5.5 4. Rh.Arthritis seems most apparent diag. Do Anti. ccp an start mefications only after u get reports

uric acid may be normal in gout
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Rheumatoid arthritis , lab values of anti CCP and anti ra antibodies

Thnx
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Sir after doing .anti CCP and ana And doing initial pain management ...put her on ayurvedic medicine .she will definitely improve well... As we can not extend long term treatment with methotrexate, indomethacin and other immunosupprest and dmrd drugs.

Thnx. Which meds do u usualy use in such cases n for how long
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Rheumatoid arthritis, start indomethacin 75mg sr od, tab sallaki 400mg bd for 10 days, do anti ccp, dsdna to confirm RA. Can add amoxicillin potassium clavunate 625 bd, rejoint uc , cap glace x od

Thnx sir
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Next step is to do a anti ccp antibody test and X-ray of the joints. UTI to be treated with T. Augmentin 625mg BD X 5 days Syp. Citralka/ Urikind 1 teaspoon in one glass water thrice daily for 5 days.

Thnx sir
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Do anti ccp as well as rule out infective arthritis. Urine culture for selecting antibiotics.till you treat symptomatically Ultracet sos for pain vit C 500 mg ; Alkaline agents (Urikind or alkasol)sos.pt to be adv for drinking plenty of water

Thank u sir. Will snd for anti ccp
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