A 27 yrs old female with complaint of ankle and wrist pain

27 year old female came with chief complaints of pain over the both the wrists and ankle of both legs since 1 & 1/2 years

History of Presenting illness

Patient was apparently asymptomatic 1 &1/2 yrs back .

 Way back in March 2019  : After 6 hours of sleep in the night she experianced pain , swelling , mild rise of temperature with restriction of movement of left elbow joint (slight flexion of elbow joint) which lasted for one and half year

September 2020: she went for physiotherapy for the right elbow joint pain 
Then 3-4 days later she started experiencing pain in the right ankle joint with pain, redness ,swelling over the joint .
Pain was progressing and radiating from lateral to medial side and then to plantar aspect of foot 
Not relieved on medication even after 15 days
Feb 2021 : She started experiencing pain over right wrist joint 

July 2021: She started having pain of left wrist and left ankle as well 

Pattern of involvement of the joints : 
left elbow - right ankle - right wrist - left wrist - left ankle

Among all , She is experiencing more pain over the Right wrist

Pain is usually more in the morning and decreased as day progresses.

She also complaints of pain in the buttock region intermittently since 4 years

 She complains of difficulty in walking since September 2020  after she started  having right ankle joint pain.

As of now ,she doesnt have any fever, headache ,burning micturition


Past history: 

Not a known case of Hypertension, Diabetes, malignancy, epilepsy ,TB and other chronic illness in the past. 
No history of any past surgeries and medical interventions in the past. 
He is a known case of hypothyroidism (but stopped the medication 2 years back)

Family history: 

No H/o similar complaints in the family. 
No h/o hypertension, Diabetes, malignancy, epilepsy ,TB and other chronic illness in the family

Personal history :

Diet Mixed
Appetite  Normal
Sleep Adequate
Bowel and bladder Regular
No substance abuse
No known drug allergies


General physical examination:

Patient is conscious, cooperative,
Oriented to Time place and person. 
Moderately Built 
Well Nourished

No Pallor 
No Icterus 
No Cyanosis 
No Clubbing 
No Edema 
No Lymphadenolathy

No sensory symptoms 

Examination 
Wrist joint : flexion limited on both sides
Extension markedly limited ( Rt>left)
Ulnar deviation : limited
Radial deviation : limited
Pronation and supination: partially able to do 

Ankle joint: plantar flexion markedly limited on right side than left
Dorsiflexion able to do 
Eversion markedly limited on right side 
Inversion able to do with difficulty

The joint involved earlier has progressed to greater limitation of movements than the one involved later.



Differential Diagnosis

Spondyloarthritis
Reactive arthritis 
Gout
Fibromyalgia
Rheumatiod Arthritis

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