45 yrs old female with wrist and ankle joint pains since 4 years.

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45 years old female came with C/O right and left wrist and ankle joint pain since 4 years

C/O neck pain since 4 years

C/O generalised weakness and difficulty in lifting weights since 4 years

HOPI:

Patient was apparently asymptomatic 4 years back and then patient developed joint pains such as wrist and ankle joint pains which is insidious in onset gradually progressive,dull aching type of a pain, associated with early morning stiffness lasts for 2 hours

Pain aggravates relatively at end of the day, associated with fever- low grade not associated with chills and rigor on and off since 4 years

Patient also complaints of small joint pains such as metacarpo phalyngeal joints and proximal inter phalyngeal joints of both the upper limbs

C/O pain in the back of the neck which is insidious in onset gradually progressive,dull aching type of pain, radiating to the occipital region and shoulder since 4 years.

C/O tingling sensation of both the soles since 2 years

C/O lower back ache on and off since 4 years

No h/o large joints involvement like knee,hip,elbow and shoulder joints.

No h/o any trauma

No h/o nausea and vomiting.

No h/o sob,cold,cough,chest pain and pedal edema

No h/o burning micturation and decreased urine output.

Past history

N/K/C/O DM, HTN, TB, Asthma, epilepsy, CVA,CAD, thyroid disorders

H/O hysterectomy done 20 years back.

Personal H/O

Diet: mixed

Appetite : normal

Bowel: constipation on and off

Bladder: regular

Sleep: adequate

Habits: occasionally drinks toddy since 12 years stopped 4 years back

Family H/O:not significant

Menstural H/O:

AOM: 13 years

15/30 cycles before.

Hysterectomy done 20 years back

General examination

Patient is Conscious, coherent, cooperative, moderately built and moderately nourished

No signs of pallor, icterus, cyanosis, clubbing, generalised lymphadenopathy and bilateral pedal edema.

VITALS

temp: 98.6F

PR: 84bpm

RR:16cpm

BP:120/80mmhg

SpO2: 98 @ RA

GRBS: 134mg/dl

Local examination:joint line tenderness is present in right and left wrist joints,MCP joint(more in 1st,2nd and 3rd) ,PIP joints and both the ankle joints and metatarsophalyngeal joint.

No local raise in temperature,redness and swelling.