27 yr old female with multiple swellings in the joints

 General medicine elog

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A 27 year old female came to opd with chief complaint of swelling on the left elbow  and right ankle joint.

History of present illness:

Two years ago after a normal sleeping hours she experienced pain in her left elbow which also showed swelling (non pitting type)in the same area i.e towards radial side of hand which resulted in restricted hand movement , this lasted for 10 months and above.no episodes of fever is seen.

Then she visited a local hospital and was give painkillers ,pain subsiding gel ointment.

An year later she experienced similar kind of pain on her right elbow too..Then she  consulted a physiotherapist and was physiotherapy sessions then pt. Claims that the pain was subsided and the hand flexion was better for a while.The pain is more in the morning hours than in the night times.

During early months of this year she had difficulty in walking because of the ankle pain  .

History of past illness:

The   patient was also on hypothyroidism medication 2yrs ago and now she stopped using medication for it.

Personal history:

No loss of appetite.

Takes mixed diet

- No sleep disturbances

- has no addictions

Family history:

No similar complaint in the family members.

Treatment history :

-patient was on medication of ibuprofen-400mg twice a day and paracetamol.

 patient has taken medications for menstrual problem 10 yrs ago

- she is not a known case of drug allergy

  Physical Examination:

Difficulty in hand flexion/constricted hand movement

Pain in the tarsal and difficulty in walking 

Vitals:

Temperature: afebrile

Pulse rate :70 BPM

Respiratory rate: normal

Investigations:

Crp

HEMOGRAM

ESR

COMPLETE URINE EXAMINATION

BLOOD UREA

SERUM CREATININE

SERUM ELECTROLYTES

ECG

Provisional diagnosis: 

Spondylar arthropathy