Details Case presentation on Rheumatoid athrities

1. Presented by:
MAKBUL HUSSAIN CHOWDHURY
Pharm. D 3rd year

2.  Rheumatoid arthritis (RA) is an autoimmune disease
that can cause joint pain and damage throughout your
body.
 The joint damage that RA causes usually happens on
both sides of your body.

3. o Age- 30 years , Male.
o Weight- 75kg.
o I.P NO.-19426694
o DOA- 09 Feb. 2018
o DOD – 14 Feb. 2018
o WARD- ORTHO

4. Patient came with C/O –
 Pain and swelling in small joints of fingers * 6 months.
 Pain in lumbar region radiating to right leg * 6 months.
 Morning stiffness in joints of fingers and toes for about 2
hours.
 Decreased grip in fingers.
 Difficulty in standing.
 No H/O DM/HTN/TB/BA etc.

5.  Family history – not significant
 Personal history – non smoker, non alcoholic ,
vegetarian by diet

6.  Pt. calm, conscious and oriented.
 R/S – B/L air entry equal. No abnormality detected.
 CVS – S1,S2 normal.
 P/A – soft , non tender , non distended
 CNS – intact
 Diffused swelling present in all small inter-phalangeal and
meta-carpophalangeal joints with redness of skin.
 No visible deformity present.

7. Vitals Day 1 Day 2 Day 3 Day 4 Day 5 Day 6
BP
(mm Hg)
130/80 130/80 120/80 110/80 110/80 120/80
PR
(/min)
76 72 74 72 72 72
RR
(/min)
24 22 24 22 22 22
Temp.
(˚F)
Afeb. Afeb. Afeb. Afeb. Afeb. Afeb.

8. Constituents Detected values Normal range
Hb 13.0 13-17 gm %
ESR 45 0-9/1ST hour
TLC 11600 4000-10,000
/cumm
CRP Positive
RA Factor Latex NEGATIVE
These tests were performed in hospital laboratory
on 9-10 feb.2018.

9. Constituents Detected values Normal range
TSH 0.85 0.35 – 5.50 µIU/ml
S. Uric acid 6.10 3.4 – 7.0 mg %
Calcium 8.30 8.0-10.5 mg/dL
CRP (quantitative) 11.70 0.0 – 6 mgm/L
RA Factor (quantitative) 18.40 ˂ 14 IU/mL
These tests were performed in some other laboratory
on 19-20 jan.2018.

10.  Nerve conduction tests – Neuropathy of left upper
limb. (17/1/2018)

11. Subjective Objective
 Pain and swelling in small
joints of fingers * 6 months
Pain in lumbar region
radiating to right leg * 6
months
Morning stiffness in joints of
fingers and toes for about 2
hours
Decreased grip in fingers
Difficulty in standing
Diffused swelling present in
all small inter-phalangeal and
meta-carpophalangeal joints
with redness of skin
↑ed ESR
↑ed TLC
CRP – POSITIVE
RA Factor – POSITIVE

12. On the basis of subjective and objective
information patient was diagnosed with
Rheumatoid Arthritis with Neuropathic pain.

14. Drug Dose and
frequency
Route Start Stop Class
Inj. Mecotop-G
(Gabapentin+
Methylcobalamine)
300 mg +
1000 mcg ,
OD
IV 9/2 10/2 Anticonvulsan
t & Neuro-
protectant
Tab. Myelin-G
(Gabapentin+
Methylcobalamine)
300 mg +
500 mcg , BD
(1-0-1)
Oral 11/2 13/2 Anticonvulsan
t & Neuro-
protectant
Tab. Defkors
(Deflazacort)
6 mg , BD (1-
0-1)
Oral 9/2 13/2 Corticosteroid
Cap. CYRA-D
(Rabeprazole +
Domperidone)
20 mg + 30
mg , OD (1-
0-0) , BBF
Oral 9/2 13/2 Proton pump
inhibitor &
Anti-emetic
Tab. Methotrexate
(Methotrexate)
7.5 mg , Once
a week
Oral 9/2 DMARD
Tab. ACECLOFLAM-
SP (Aceclofenac +
PCM
100 mg +
325 mg + 10
mg , BD (1-
Oral 9/2 13/2 Analgesic &
Anti-
inflammatory

15. Drug Dose and
frequency
Route Start Stop Class
Tab. HCQ
(Hydroxychloroquine
Sulphate )
200 mg ,
OD (1-0-
0)
Oral 9/2 13/2 Anti-
inflammator
y
Tab. Sazo
(Sulfasalazine)
500 mg ,
BD
(1-0-1)
Oral 9/2 13/2 Sulphonami
de &
DMARD
Cap. Oxuba
(Oxaceprol)
200 mg ,
BD
(1-0-1)
Oral 9/2 13/2 Anti-
inflammator
y
Tab. Revozyme Forte
(Trypsin+Bromelain+
Rutoside Trihydrate)
96 mg +
180 mg +
200 mg ,
OD
(0-1-0)
Oral 12/2 13/2 Anti-
inflammator
y enzymes

16. SHORT TERM GOAL-
o To provide symptomatic relief from pain of joints and
lumbar region pain.
o To reduce inflammation.
LONG TERM GOAL-
o To prevent or control joint damage.
o To preserve function of joints.
o To decrease the mortality.
o To improve quality of life.

17.  Liver function tests.
 CBC (for leucopenia ,thrombocytopenia , anemia)
 Blood calcium levels.
 Serum Albumin levels.
 Renal function tests.
 Fundus examination.

18.  BP- 120/80 mmHg
 PR- 74/min.
 RR – 22 /min.
 Afebrile
 Swelling present(↓) over interphalangeal joints and
metacarpophalangeal joints.

19.  Tab. Myelin-G 1*BD
 Tab. Defkors 6 mg 1*BD
 Cap. CYRA-D 1*OD (BBF)
 Tab. Methotrexate 7.5 mg 1*week
 Tab. HCQ 200 mg 1*OD
 Tab. SAZO 500 mg 1*BD
 Tab. Oxuba 200 mg 1*BD
 Tab. Revozyme 1*OD
 Tab. ACECLOFLAM –SP 1*BD
(For 15 days)

20.  Exercise regularly to relieve pain and improve activity of
joints.
 Take adequate rest. It will help in reducing inflammation.
 Prolonged inactivity may lead to stiffness and loss of joint
motion, as well as muscle wasting and osteoporosis.
Therefore there should be an appropriate balance of rest
and exercise.
 Avoid unnecessary stress.

21.  Adhere to the medication.
 Tab. Methotrexate is to be taken is to be taken once a week.
 Do not avoid symptoms like nausea , vomiting , mouth
ulcers , dizziness , shortness of breath, easy bruising or
bleeding etc.
 Do not worry ,If your skin color and urine color appears
yellow orange as it is because of sulfasalazine.
 Do not drive or handle machinery after taking Tablet
Myelin-G .
 Avoid prolonged exposure to sunlight and use sunscreen
(SPF 15 or higher) when outdoor.
 Keep Tab. Defkors away from persons having Chicken pox ,
Measles & if you do catch them , immediately report about it
to Physician.