61years old male patient with Rheumatoid arthritis and Diabetes mellitus
61years old male patient resident of suryapet farmer by occupation came to casualty Chief complaints : Pain in bilateral wrist and bilateral knee, bilateral ankle joint since 1year History of present illness: Patient was apparently asymptomatic 7yrs back then he visited local hospital for excessive urine output he was diagnosed as diabetic at local hospital since then he was on medication and was on regular checkup monthly with dietary practices . He developed pain in b/l wrist ,knee ,ankle joint since 1year it was sudden in onset gradually progressive in nature .Type of pain is pricking type . He visited local hospital he was given medicine for that from he taken medicine regularly form past 1week pain is increasing . He developed decrease vision in left eye from past 3months .He admitted in the local hospital and it is treated by surgery. H/o SOB 2months back which was relived by injection by local doctor last episode was 10days back . Each episode last for 10 min. He quit his wo