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 work 1 years ago and is only staying at home since then.

Daily routine :

Wake up at 6am

Drink tea-7am

Take ghatka -10am

Lunch-rice -1pm

Dinner-jonna rotti -8pm

Sleep -10pm

Past history:

▪ Known case of diabetes since 7 years 

.surgery to the left eye 3 months back

▪No history of hypertension, asthma, epilepsy, CAD

Family history

No significant family history

Personal history

 Diet- mixed

Appetite- normal 

Sleep- adequate

Bowel and bladder movements- regular

No addictions

General examination

Patient was conscious , coherent, cooperative well oriented to time , place person 

Pallor- absent

icterus- absent

cyanosis- absent

clubbing- absent

Lymphadenopathy - absent

Edema- absent

Vitals 

Temperature-afebrile 

Respiratory rate - 28cpm

Pulse -76bpm

Bp-120/80mmhg

Systemic examination

CVS-- s1 ,s2 heard no murmurs

 • Respiratory system- normal vesicular breath sounds heard

 • Abdomen- no tenderness no. . palpable mass 

CNS-

 -Patient is conscious

-Speech -normal

-No signs of meningeal irritation

-SENSORY EXAMINATION,- touch, pain , vibration present

-No muscle wasting seen

Local examination 

Inspection:

Swelling : absent 

Scars : absent

Deformity- absent 

Palpation:

Temperature - no local rise in temperature

Tenderness - present 

Crepitus -absent 

Movements : 

Flextion -: Right :0-120 , left 135-140

Extention - 0 degree in both right and left 

INVESTIGATION : 

Diagnosis :

RHEUMATOID ARTHRITIS & DIABETES MELLITUS