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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 !!!