26 year old woman with multiple joint pains
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I have been given this case to solve in an attempt to understand the topic of " patient clinical data analysis" to develop my competency in reading and comprehending clinical data including history, clinical findings, investigations and come up with diagnosis and treatment plan
A 26 year old female graduated in MSc chemistry presented to our outpatient unit with the complaints of
Multiple joint pains since the past 2 years.
Present Illness:
A 26 year old female was apparently asymptomatic 2 years back after which she started experiencing multiple joint pains. She reported that she first experienced right proximal interphalangeal joint pain 2 years back. After 2 weeks she started to experience left proximal interphalangeal joint pain. Over the last 2 years, she started experiencing multiple joint pains - bilateral meta-carpophalangeal joints, with involvement of bilateral elbow joint, bilateral ankle joints ( intermittently). She reported early morning stiffness lasting for more than an hour which would be relieved on physical activity. She would experience these pains intermittently and would often be accompanied by swelling of the joint and would be relieved on taking pain medications. She reported that she developed bilateral little finger and Ring finger ( 4th and 5th PIP) deformity 1 and half year back.
She however gave no history of fever, oral ulcers, rash, dryness of the skin, hair loss, any development of rash on exposure to sunlight, discouloration of skin on exposure to cold.
No other constitutional symptoms like fever, fatigue, weight loss.
Past History:
No other significant past history
Personal History:
She is happily married and gravida with 10 weeks of Gestation. She has a good appetite, normal bowel and bladder movements.
Family History:
No significant family history
Provisional Diagnosis:
Chronic, multiple, symmetrical joint involvement, involvement of PIP & DIP joints - ? Rheumatoid Arthritis
Examination:
Pulse Rate: 75 beats per minute
Blood Pressure: 120/70mmhg
Respiratory Rate: 22 cycles per minute
Temperature: 98.6 F
No pallor, icterus, cyanosis, clubbing, lymphadenopathy, edema
General Examination:
Hair:
Normal hair distribution, normal texture, colour
Eyes:
No conjunctival injection, no erythema, no corneal lesions
Oral Cavity:
No mucosal ulcers
Nails:
No nail pitting, onycholysis, onychodystrophy
Skin:
No rash , ulcers over the skin, scaly lesions, dryness of skin, thickening of skin, no rash on sun exposed areas of the skin, no subcutaneous nodules
Spine:
No spinal deformity
Musculoskeletal System Examination:
Gait: Normal
Musculoskeletal system:
Upper limbs:
Boutenniere' or button hole deformity of the right ring finger & little finger ( 4th & 5th PIP)
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