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

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

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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