50 Yr Male Came with C/O B/L knee pain since 1 year
CBBLE UDHC SIMILAR CASES
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HOPI :-
Patient Was Apparently Asymptomatic 4 years Back , Then He Developed Bilateral Knee joint Pain ( Insidious In Onset, Gradually Progressive ) On & off , went to Rural Community Practisioner And Given Medicine , The Patient Had Been Taking pain management Medication when he has Joint Pain . Swelling was also present at the knee and Ankle joints during during Pain . The patient was abke to do his Routine farming Activities for 2 years .
Since 2 years the patient stopped doing farming works and used to stay at home and was able to take care of his own . When patient has pain he used to take rest and On severe pain patient used to take medication given by rural community Practisioner. Pain was not completely releived On taking medication but patient used to feel better.
The pain was aggravated since 1 week and the patient was unable to walk , bear weight , take care of himself and was admitted in our Hospital , Diagnosed with Hyperurecemia & Dimorphic Anemia .
In Hands : Pain Initially Starts In the wrist , swelling apears ( flexion occurs at metacarpal-phalanges joint ) for 1-2 days , and pain Migrates to the elbow ( Unable to Flex completely , Swelling + ) for 2 days and then pain Migrates to shoulder ( unable to lift, abduct the Shoulder). and then the other hand involves
Pain Is Assymetrical ( when one hand is involves the other is not involved )
In Legs : pain initially gets started in the ankle joint ( Swelling + , duration 1-2 days ) and pain Migrates to knee ( unable to bear weights , walks with the help of stick/ support , swelling + , duration 1-2 days ) and then the pain Migrates to the Hip joint
Pain Is Assymetrical ( when one leg is involves the other is not involved )
No C/O Diarrhoea & Vomitings
No C/O Shortness of Breath , Palpitations , Ornthopnea ,PND
Not a Known Case of DM, HTN ,TB , Epilepsy , Asthma
No Similar Complaints in the Past
Family History :
No Similar Complaints In the family
Personal History :
1) Alcohol : Used to consume Toddy twice a week 6-7 years Back .Now Completely Stopped Consuming Alcohol
Appetite Decreased
Bowl & Bladder movements Normal
Food : mixed , since 3-4 years back stopped consuming chicken & meat
GENERAL EXAMINATION
NO Icterus , Cyanosis , Clubbing ,lymphadenopathy.
PALLOR +
Vitals
Temp - afebrile
BP - 100/60 mm hg
PR - 82 bpm.
RR - 19 cpm
spo2 100 @RA
GRBS - 158 mg/dl @ 8 am
CVS - S1, S2 heard
RS - bae present
P/A - soft , tender , Guarding Present
CNS - NAD
Examination Of Joints
Wrist joint : Partial Movement of flexion and extension approximately 30-45 degrees
Swelling + at Wrist joint
Fingers : unable to completely flex phalanges, Stifness +
Knee & ankle joint : Unable to flex completely , but can flex upto 30 degrees
Swelling + , Stiffness +
Elbow : can flex and Extend Normally
Shoulder : can lift shoulders above the head but not 180 degrees at shoulder Joint.
During pain unable to lift the bucket
INVESTIGATIONS
HAEMOGRAM
Haemoglobin - 4.6
Total Count - 10,200 cells / cumm
Rbc - 1.76 million / cumm
Platelet Count - 2.40 lakhs
Reticulocyte Count - 0.8 %
ESR - 150
RA Factor - Negative
Peripheral Smear :
RBC Normocytic normochromic with few microcytes tear drop cells pencil forms
WBC With in normal limits absolute neutrophilia
PLATELET Adequate
Synovial Fluid
Sugar - 140 mg/dl ( 60-100 mg/dl)
Protein - 4.2 mg/dl ( 10-45 mg/dl )
Uric Acid - 10.7 mg/dl ( 10.7 mg/dl )
Synovial Fluid Cell Count
Colour - Yellowish
Appearance - Cloudy
Total Count - 29000 cells
Monocytes - Nil
Neutrophils - 95 %
Lymphocytes - 05 %
RBC - Nil
LDH - 240 IU/L
RFT
Blood Urea - 56
S Creatinine - 1.6
S Uric Acid -
Na - 130
K - 3.7
Cl - 92
CRP - Negative
ApTT - 31 sec
PT - 15 sec
INR - 1.11
Blood Group - B Positive
Synovial Fluid Cytology
XRay
ECG
2D Echo
PROVISONAL DIAGNOSIS
Anaemia Under Evaluation with ? Iron Deficiency Anemia with Rheumatoid Arthritis ( seronegative ) with Hyperurecemia
Treatment
1) Inj Monocef 1 gm IV / BD
2) Tab Methotrexate 7.5 mg / PO Weekly Once
3) Tab Folvite 5 mg / PO weekly Once
4) Tab Prednisolone 10 mg / PO / OD
5) Tab Colchicine 0.5 mg PO/BD
SOAP NOTES
Ward Day 3
S :
C/o Pain B/L Knee Joint Pain Decreased
O - Patient is conscious,coherent,cooperative.
Now Patient Is Able to walk after aspirating 15-18 ml of Synovial fluids from both the legs on 17/03/2022
vitals :
Temp - afebrile
BP - 120/80 mm hg
PR - 90 bpm.
RR - 18 cpm
spo2 - 100 @RA
GRBS -
CVS - S1, S2 heard
RS - bae present ,
P/A - Soft , non tender
CNS - NAD
A - Anaemia Under Evaluation with ? Iron Deficiency Anemia with Rheumatoid Arthritis ( seronegative ) with Hyperurecemia
P -
1) Inj Monocef 1 gm IV / BD
2) Tab Methotrexate 7.5 mg / PO Weekly Once
3) Tab Folvite 5 mg / PO weekly Once
4) Tab Prednisolone 10 mg / PO / OD
5) Tab Colchicine 0.5 mg PO/BD
Ward Day 4
S :
C/o Pain B/L Knee Joint Pain Decreased
O - Patient is conscious,coherent,cooperative.
vitals :
Temp - afebrile
BP - 120/90 mm hg
PR - 85 bpm
RR - 16 cpm
spo2 - 99%@RA
CVS - S1, S2 heard
RS - bae present ,
P/A - Soft , non tender
CNS - NAD
A - Anaemia Under Evaluation with ? Iron Deficiency Anemia with Rheumatoid Arthritis ( seronegative ) with Hyperurecemia
P -
1) Inj Monocef 1 gm IV / BD
2) Tab Methotrexate 7.5 mg / PO Weekly Once
3) Tab Folvite 5 mg / PO weekly Once
4) Tab Prednisolone 10 mg / PO / OD
5) Tab Colchicine 0.5 mg PO/BD
