The mother of this boy presented with inability to walk without support and seveer pain both knees. She was found to have Severe Osteoarthritis - (OA Garde IV) with major functional limitations.
After treatment good functions with reduced pain seen. No support required for daily activity of living. No Joint replacement done in followup since more than 3 years.
This Patient presented with Psoriatic Arthritis with high disease activity and Major Functional Limitations. Six months disease modification along with Multi-pronged treatment resulted in Full remission and Complete functional recovery.
Lady with severe active steroid dependent Rheumatoid Arthritis with High Disease Activity at presentation. High functional limitations due to disease and deformities were seen. The patient is in Steroid free Remission after 6 months treatment. Patient and Family counselling was the Important treatment plans besides Disease modification.
Behavioral and environmental findings were:- Anxiety and family discord present Obesity and self consciousness noticed Not following diet advise and indulgence in Junk food binges Not following exercise advise Taken multiple consultations from many doctors and blotched up treatment & follow up Finally diagnosed and Treated as Secondary Fibromyalgia Syndrome with good results.
All follow up investigations were done: Clinical Findings - No SJC, TJC, or deformities Multiple painful joint movements, tender points Laboratory and Radiological Findings - Haemogram - Mild anemia, CRP and ESR, Thyroid Functions, X Ray Cervical spine were all within normal limits while in X Ray Knees, Secondary Grade III OsteoArthritis as seen. These could not explain her problems. Her Bone Mineral Density was showing Osteopenia ( T scores= -1.3 spinal).
What are we looking at as a Co Morbidity of Rheumatoid Arthritis? We had to look for or rule out : 1. RA Disease flair / Sjôgren's syndrome 2. Primary DMARD and Biologic failure 3. Chronic MSK damage and deformities 4. Chronic pain syndrome 5. Associated FMS
In Follow up she presented with Methotrexate intolerance -- Patchy hair loss and severe nausea. Methotrexate was STOPPED and HCQ added. Good disease control (DAS28 below 3) achieved within 6 months Life style education and counseling. Sustained remission of disease activity seen for 3 years.
10 years ago - a 30 year old lady after giving birth to her second child one year before presented with Poly-arthritis of hand and feet associated with rest induced stiffness.
A 20 year old Lady came with her mother with pains all over the body, difficulty in coping with any activity, sleep disturbance, Short temper and depression. All laboratory tests were normal. She had been to many doctors before and labeled and treated for Severe Depression, & Anorexia Nervosa. She had a very poor faith in Medical Fraternity and a very negative approach towards possibility of any treatment or cure.