59/Y with asymmetrical oligoarithritis

June 20, 2023

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Cheif complaints

59 Y came with cheif complaints of pains in finger joints, wrist joint, ankle joint for the past 22 years

HOPI

in 2000s ,he got swelling at 1st MTP with severe pain , swelling developed in a day , joined in a hospital for 10 days but no diagnosis , then after the swelling subsided another leg got swelling .sometimes both at once usually aggravates after heavy dinner ( mutton ,fishes, tamarind, curd) could not sleep that day. involved all other limbs ankle, wrist , elbows , left shoulder , severely affected on right side for 23 years , cannot do work as before sudden loss of consciousness but didnt fall, for 3 times hypertensive (140/80mmhgsince 2 years on medication( found out giddiness with sweating)

intermittent pedal edema insidious onset, gradually progressive , pitting type not associated with pain ,In night upto ankle aggravated on tamarind and curd relieved by it's own or medication. burning micturition since 1 and half month,increased frequency of urine,4- 5 times at night.

Patients gives history of joint pain involving in ascending order (like first DIP Then PIP then MCP then wrist joint)

PAST HISTORY:-

K/c/o HTN For the past 2 years and on medication

N/k/c/o DM, Thyroid, Asthma, CAD, CVA, Epilepsy

FAMILY HISTORY:-

Insignificant

PERSONAL HISTORY:-

Course of life events

COURSE OF LIFE EVENTS:

58 male hailing from narayanapuram ,choutuppal,

born in 1964

A 6 years got seizures,

from 7th class he got one sided headache associated with bilious vomiting ( stopped at 32 years)

studied until 10th class ,kabaddi player long jump(13feet) ,

he started smoking,

From 1990 he started consuming alcohol,1994 he got job as a supervisor in mumbai , got addicted to gambling and alcohol 75ml per day for 15 years , usually smokes 30 cigarrette per day for 15 years , Rich person at those times, usually takes high protein diet. admitted in hospital for cold with headache done spinal injection( lumbar puncture ? meningitis?)for 20 days . He quit smoking and alcohol there after .He quit job in mumbai due to some brother disputes and lost his money .He does real estate and also upasarpanch has anger episodes

GENERAL EXAMINATION:-

Patient is conscious , coherent & co-operative

Well built and nourished.

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

Vitals @ admission

Temp - 99.2F

RR -18CPM

PR - 132BPM

BP - 140/80mmHg

Spo2 - 99% RA

SYSTEMIC EXAMINATION:-

Respiratory system:-

Bilateral air entry present

NVBS heard

Cardiovascular system:-

S1, S2 heard

CNS:-

NFND

Abdomen:-

Soft, Non tender

Local Examination of joints

Right hand

local raise of temperature present ,diffuse swelling in wrist and at carpal bones in right hand , tenderness and restriction of movements present in,wrist, mcp joints and pip joints

Left hand

Inspection :swelling present

PALPATION:tenderness, local raise of temperature

crepitus cannot be demonstrated

synovial thickening absent

Range of movements - active - ,restrictedpainful

passive ,restricted ,painful

ANKLE JOINT

inspection normal

palpation

fine crepitus can be felt at bare area

no synovial thickening