36Year Old Female Patient With Multiple Joint Pains
36YEAR OLD FEMALE WITH JOINT PAINS, MALAR RASH, ORAL ULCERS
A 36 years old female patient came with chief complaints of
Multi joint pain since 2 months ,morning stifness of joints since 1 month ,Menorrhagia since 1 month
HOPI
Patient was apparently asymptomatic 2 months back, then she had rapid weight gain, menorrhagia, multiple joint pains, she visited a hospital and was found that her TSH was >100 mlU/L and was started on THYRONOME 100 micrograms.
Her menorrhagia subsided, but she continues to have multiple joint pain (all small joints and large joints) associated with swelling of joints, morning stiffness for 30mins, on evaluation she was found to have CRP (+), Hb-10.8gm/dl, Uric acid-7.8 and was started on T. ALLOPURINOL100mg BD.
Her joint pains are associated with on and off low grade fever since 2months, using T.PCM 650mg BD since 2months.
On Dec 29th:
ANA- 3.18(if >1.2 strongly positive)
Anti CCP -1.4 UI/ml (Negative)
Rh factor- Negative
TSH -16.9 (continued on T. THYRONOME 100 micrograms)
Since 5 days Patient tellsthat her joint pains and swellings subsided
C/O oral ulcers since 20 days
C/O Blackish spots over malar aspect of face since 15days
MRI spine done 3/1/22 - Multiple level disc protussion causing thecal sac indentation and B/L C5-C6 mild neural foraminal stenosis
PAST HISTORY
K/C/O Hypothyroidism (on T.THYRONORM 100 micrograms)
N/K/C/O DM, HTN, CAD
No previous hospitalisation
O/E
Pt c/c/c
Pallor (+)
No Icterus/cyanosis/koilonychia/generalised lymphadenopathy/pedal edema
Temp-99.6 F
Pr-115bpm
BP-110/80 mmhg
Rr-21/min
Spo2-98% @RA
GRBS-132 mg/dl
Ulcer over left lateral aspect of tongue
Goitre(+)
Cvs-s1 s2 +,no murmurs
R/S- bae+,nvbs
Cns-no fnd
P/A-soft,nt
PROVISIONAL DIAGNOSIS
Sero negative arthritis (2° to RA ?SLE) with k/c/o hypothyroidism
INVESTIGATIONS
