TBL Joint Pain

TBL : JOINT PAIN

Case Scenario

Name :

Age : 25

D.O.A : 7 / 4 / 2015

Chief complaints- Joint pain for 3 years - Diarrhea for 3 weeks

History of Presenting Complaint• Joint pain – bilateral , symmetrical

polyarthritis affecting the small joints of the hand and feet , wrists , elbows , shoulders , hips , knees and ankles

• Associated with joint swelling – relieved with prednisolone

• Morning stiffness - lasting more than one hour. • Painful mouth ulcers • Occasional hair loss • Fatigue – often feels tired and sleepy.

• No history of trauma or injury

Systemic Review

• General : Loss of weight by 3 kg over the past 3 months.

• CVS :• Respi : No cough , no S.O.B • Renal : Frothy urine , no haematuria , no

dysuria

Past Medical History

- Admitted to HTJ Seremban in year 2012 due to pleuritic chest pain.

- Underwent blood tranfusion in November last year.

Drug History

Investigations

a) Full Blood Count

WBC

RBC

Hb

Hc

MCV

MCH

MCHC

Neutrophil

b) Renal Function Test

Urea Creatinine Albumin Total proteinBilirubin

c) Coomb’s Test : Negative

d) ESR : 60 mm/hour (INCREASED)

Management

Clinical Features

Serositis

Oral ulcers

Arthritis

Photosensitivity

Blood disorder

Renal disorder

ANA positive titre

Immunological disorder

Neurologic disorder

Malar rash

Discoid rash

Remember the mnemonic SOAP BRAIN MD !!!