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47 year old teacher, BMI 31kg/m2 c/o pain in right knee. she id afebrile…
47 year old teacher, BMI 31kg/m2 c/o pain in right knee. she id afebrile and vitally stable
HISTORY
onset
acute<6 weeks
chronic > 6 weeks
knee pain
joint itself ( articular)
joint pain involving surrounding (periarticular)
h/o anxiety, depression, diabetes, obesity, hypothyroid, DVT,, vascular, neurological
h/o trauma, fracture
no. of pregnancies, menopause? past surgical histories
long standing activities
family history of gout, hypothyroidism, diabetes, hypertension, DVT, venous thromboembolism
morning stiffness
h/o STDs/ TB/.prosthesis, immunocompromised
INVESTIGATION
X-Ray knee joint AP+ LAT view
serum calcium and vitamin D levels
TSH
CBC
Serum uric acid levels
lipid profile
ESR
CRP
synovial fluid culture
fasting blood sugar
MANAGEMENT
pharmacological
analgesics for gout
NSAID
antimicrobials for septic arthritis
uricosuric drugs
intraarticular or systemic steroids in crystal induce arthritis
antibiotics for septic arthritis
levothyroxin for hypothyroidism
Selective Serotonin Reuptake Inhibitors ( SSRI)
vitamin D
calcium supplements
non-pharmacological
weight reduction
exercise
lifestyle modification
REFERENCES
oxford handbook of general practice
oxford handbook of family medicine
NICE rheumatology guidelines
British society of rheumatology guidelines
EXAMINATION
weight
blood pressure
respiratory rate
temperature
knee examination
warmth
swelling
tenderness
skin changes
reflexes
knee jerk
deformity
asymmetry
effusion
focal and point tenderness
motor and sensory examination
hairloss, mouth dryness, skin dryness, eye dryness
malar flush/ photosensitive rash
DIFFERENTIALS
rheumatoid arthritis
systemic lupus erythematosis
GOUT
psoriatic arthritis
reactive arthritis
sarcoidosis
Sjogren syndrome