RHEUMATOID ARTHRITIS.

CASE PRESENTATION ON RHEUMATOID ARTHRITIS,
IN SOAP FORMAT.

1. CASE PRESENTATION ON RHEUMATOID ARTHRITIS Liza Basumatary , Manasi , Divya

2. RHEUMATOID ARTHRITIS It is an autoimmune disease and chronic inflammatory disorder affecting many joints, including those in the hands and feet. Rheumatoid arthritis affects joint linings, causing painful swelling. Over long periods of time, the inflammation associated with rheumatoid arthritis can cause bone erosion and joint deformity.

3. PATIENT DETAILS Name : xyz Gender : female Age : 58 year old Weight : 60 kg Height : 5 feet Admitted in E-ward

4. SUBJECTIVE DATA CHIEF COMPLAINTS : pain & swelling of joints, early morning stiffness of joint present, joint pain associated with intermittent fever PAST MEDICAL HISTORY : NIL PAST MEDICATION HISTORY : NIL

5. OBJECTIVE DATA PHYSICAL EXAMINATION : patient is conscious oriented TEMPERATURE : 100.4 °F (98.6 °F/37°C) PULSE RATE : 80 bpm (60-100 bpm ) RESPIRATORY RATE : 22 cpm (12-20 cpm ) BP : 130/90 mmHg (90/60mmHg-120/80mmHg) SYSTEMIC EXAMINATION CVS : S1S2+ RS : B/L AE+ CNS : NAD P/A : SOFT OTHER TEST : Radiographic examination – x-rays (rheumatoid nodules found)

6. Lab Investigations CBC : RBC : 4.7 million/mm10 3 (4.4-6 million/mm10 3 ) ESR : 59 mm/ hr (0-20 mm/ hr ) PCV : 32 % (36-48%) DC : N-64% (49-74%) L-29% (26-46%) E-24% (0-50%) MCV – 68 (80-100) , MCHC – 29 (33.4-35.5) BLOOD SUGAR : RBS – 92 mg/dl (80 mg/dl-130 mg/dl) LIVER FUNCTION TEST T. BILIRUBIN : 0.9 g/dl (0.3-1.2) D.BILIRUBIN : 0.1 g/dl (0.0-0.2) SGPT : 23 μ /L ( upto 40) SGOT : 25 μ /L ( upto 40) ALBUMIN : 4.2 g/dl (3.5-5.5) GLOBULIN : 8.7 g/dl (2.3-3.5)

7. ASSESSMENT DIAGNOSIS : RHEUMATOID ARTHRITIS

8. TREATMENT SR. NO. BRAND NAME GENERIC NAME DOSE FREQUENCY ROA DAYS 1. T. MICROCID INDOMETHACIN 2.5 mg BD ORAL 4 days 2. T. SAZO SOLFAZALINE 500 mg BD ORAL 4 days 3. T. MEXIF MEFOXICAM 2.5 mg TID ORAL 4 days 4. T. OMNECORTIL PREDNISOLONE 40 mg OD ORAL 4 days 5. T. FOLVITE FOLIC ACID 5 mg OD ORAL 4 days

9. DISCHARGE MEDICATION T. PREDNISOLONE – 40 mg – OD – ORAL – 3 months T. SAZO – 500 mg – BD – ORAL – 3 months T. FOLVITE – 5 mg – OD – ORAL – 3 months T. ASPIRIN – 150 mg – OD – ORAL – 3 months

10. INTERACTIONS T. INDOMETHACIN interacts with T. PREDNISOLONE So, we can prefer PREDNISOLONE over INDOMETHACIN as being more efficacious.

11. PATIENT COUNSELLING Rest should be taken as it relieves stress on inflamed joints and prevents further destruction Increase and maintain mobility Physiotherapy should be done at regular intervals Avoid exposure to allergies and dust particles Do not lift heavy objects Regular physical and breathing exercise Do heat, cold or electrotherapy to reduce pain and swelling in the joints Use supportive devices like walkers, splints to protect joints from excessive stress Medication adherence should be maintained

12. REFERENCE https://www.1mg.com/ https://www.drugs.com/ https://www.healthline.com/ https://www.webmd.com/