70yr F with spondyloarthropathy with oligoarthritis with hypoalbuminemia

70yr old female, resident of ramannapet,who is a fruit seller by occupation
Presented with:
Fever with generalised bodypains since 15days
Swelling and pain in upper limbs and lower limbs since 4 days.
HOPI:
Pt was apparently asymptomatic 15days back.Then while taking water from well she had pain in right hip region since 15 days.
Sudden in onset,non radiating,aching type.
No h/0 trauma.
Next day she developed low grade fever, intermittent type ,not associated with chills and rigors,Subsided on taking medication. 
 The next-day she had swelling of both upper and lower limbs.
Swelling gradually progressing proximally.
Upperlimbs - till elbow
Lower limbs- till knee,pitting type
Pt had decreased urine output for one day
Generalised bodypains and joint pains.
C/o pains on movement of lower limbs
She had hlo cannulation to both wrists by local rmp ,after that she had pain in the upper limb . 
No h/o prolonged immobilisation.
NO h/o loose stools,pain abdomen, burningmicturition, hematuria, vomitings,chestpain, palpitations.
No h/o weight loss.No h/o sob.
Past history:
No h/o similar complaints in the past.
NO H/O HTN ,DM, THYROID ABNORMALITIES, ASTHAMA.
Hysterectomy done 30yrs back.
Pt has h/o tobacco chewing and betelnut chewing since 50yrs
O/E: pt is conscious and coherent
Pallor +,B/L pedal edema +.
 No icterus, cyanosis, clubbing, Generalised lymphadenopathy.
Febrile
Bp 150/90 mmHg
Pr 107 bpm
Local examination:
Rt upper limb- Normal
Lt upper limb- pitting edema till elbow
Local rise of temperature present
B/L LOWER LIMBS-
(Diffuse pitting edema of both lower limbs present upto mid thigh)
Local rise of temperature present
Movements of left hip,knee,ankle painful.
CVS: S1, S2 heard, no murmurs
Respiratory system: Bilateral air entry present, normal vesicular breath sounds heard, no added sounds heard
P/A : soft,non tender
CNS: NAD
Provisional diagnosis:
Spondyloarthropathy with oligoarthritis with hypoalbuminemia







left knee
Treatment:
Inj.MONOCEF 1GM IV BD
Inj.PAN 40MG IV OD
Tab ULTRACET 1/2 TAB QID
Inj.TRAMADOL 1 amp in 100 ml NS iv BD
IVF NS 50ml / hr
Tab DOXY  100 mg BD
Tab PCM 500mg TID
CAP.BECOSULES  OD
Protinex powder 2 TSP in milk TID
Thrombophobe ointment L/A 
Glycerine+Mgso4 dressing
Tab.INDOMETHACINE
CANDED OROPASTE L/A
Normal saline mouthwash





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