Polyarthritis - Coexisting Gout and Rhuematoid Arthritis

November 17, 2021

Polyarthritis - Coexisting Gout and Rhuematoid Arthritis

A 70 year old male,who used to work as a Mason till the age of 65 years , stopped working since 5 years because of joint pains and swelling.

1) Patient gives h/o multiple joint pains since 3-4 yrs, initially started in small joints of hands and feet and later progressed to involve ankle, knee, wrist, elbow and shoulder joints. It started as a swelling along with stiffness of joints and now progressed to deformity. This is associated with fever and difficulty in performing daily activities.

Patient also complained of lower back ache , dragging type at sacral region since 2 years ,non radiating ,not associated with tingling or numbness

2) Since 6 months -patient c/o instability while walking/climbing stairs predominantly with right knee joint.

Patient also c/o sudden onset of giving away / instability of right knee joint ,while walking or climbing stairs ,hence using stick for support

- also complaints of difficulty in getting up from sitting/squatting position.

3) Since 1 month -c/o neck pain,non radiating , dragging type with restriction of neck movements.

No tingling or numbness .

H/o using NSAIDS for 1 yr.

H/o pedal edema since 1 yr(pitting type)

Facial puffiness+(resolves spontaneously)

Oliguria -

SOB-

Not a k/c/o DM, HTN, Asthma, Epilepsy.

General examination:

Pallor-N

Icterus-N

Cyanosis-N

Clubbing-N

Bp-120/80mmHg

SpO2 at RA-99%

PR-88bpm

Respiratory rate-19cpm

Temperature-98. F

Systemic examination:

CVS-S1S2+,No murmurs heard

Respiratory system-BAE+,NVBS

Musculoskeletal system-

Hands :thumb-boutinerrie deformity

Fingers:swan neck deformity

Joint swellings +

Synovial thickening at MCP, PIP joints

Small nodules at DIP joint

Tenderness at MCP, PIP joint

Flexion deformity of little finger both hands

Wrist:Joint tenderness+

Restriction of movements

Elbow:Subcutaneous nodules + at elbow

Knee: crepitations are felt at Right knee

Ankle : Swollen joint

Tenderness+

Schobers -4 cm increase

Past investigations and treatment -

He visited multiple hospitals for above complaints ,his uric acid was always at 7-9 ,RA factor was negative.

He used febuxostat ,NSAIDs , Wysolone intermittently for.

involvement of PIP and fixed flexion deformity of little finger seen.

FNAC of subcutaneous nodule - revelead negative bifiringet needle shaped crystals ,we can see neutrophils engulfing crystals . Macrophages are also seen .