A 28yr old female with complaint of pain over the small joints DIP , PIP, wrist, shoulder and knee joints

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Name :- P. Sai Krupa Sri (intern) 
Roll no:- 113 

A 28yr old female came with complaint of pain over the small joints DIP , PIP, wrist, shoulder and knee joints 

History of present illness:- 

Patient was apparently asymptomatic 1 yr back then developed pain and swelling over the small joints DIP, PIP, wrist, shoulder, knee joint, insidious in onset, gradually progressive, initially diagnosed as rheumatoid arthritis used medication for 3 months pain and swelling reduced after medication , discontinued medication (after which symptoms aggravated)  and now presently since 1 month using ayurvedic medication and symptoms are relieved.

Past history:- 
K/c/o hypothyroidism since 5-6 yrs ( initially on tab. Thyronorm 100mcg 1yr back changed to tab. Thyronorm 125mcg ) 

N/k/c/o DM, HTN , asthma , epilepsy, TB ,CVA,CAD 

Personal history:- 

Diet- mixed
Appetite - normal 
Sleep - adequate 
Bowel and bladder- regular 
No allergies 
No Addiction 


Family history:- 

Not significant 

Menstrual history:- 

Aom- 13yrs 
Menstrual cycle - 5/30days 

General examination:- 

Patient is conscious, coherent, co operative 

No Pallor, icterus, cyanosis, clubbing, lympadenopathy , edema 

Vitals:- 

Temp:- 98.7f 
Pr- 88bpm 
Rr- 16cpm 
Bp- 120/80mm hg 
Spo2- 99% 


Systemic examination:- 

Cvs- S1S2 heard , no murmurs 
Rs- BAE present , NVBS present 
P/A - soft , non tender 
CNS- NAD 






Investigation:- 
Hemogram :- 
Hb- 11.8
TLC- 10,000
PLT- 3.4

Crp- negative 
RA factor - negative 
ESR - 23 

T3: 0.65 
T4: 12.25 
TSH: 3.28 

Provisional diagnosis:- 

Rheumatoid arthritis with hypothyroidism 

Treatment:- 

Tab. Naproxen 250mg PO/BD 
Tab. Benfothiamine 100mg PO/BD 
Tab. Thyronorm 125mcg PO/OD 



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