A 70 year old male came to the medicine OPD with the chief complaint of difficulty in walking due to joint pain since 15 years.

                    GENERAL MEDICINE 

                                         ~Case Discussion 

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A 70 year old male came to the opd of General Medicine with the chief complaint of difficulty in walking due to joint pain since 15 years.

 Apparently the patient was asymptomatic 10 years ago, later he developed multiple joint pain ( mainly backpain ) which was insidious in onset, gradual in progression , non radiating, stabbing / piercing,  grinding type of pain. Aggravated on walking and other movements, relieved on resting. He is also experiencing morning stiffness since 15 years.

          He is also complaining of intermittent distal interphalangeal joint swelling for every 15 - 20 days when he has severe pain. He is also complaining of painless deformity of right leg great toe.

 Past illness:

 He has no history of similar complaints in the past. 

10 years ago, he has been hanged to a tree upside down as a part of local treatment for hernia.

He has undergone hernial operation 5 years ago.

5 years ago he has developed a swelling at elbow .

Personal History:

Not a known case of Diabetes, Hypertension,  thyroid disorders. 

Has normal appetite 

 Consumes Mixed diet

Constipation for 3 days every week

Smokes 1 cigarette per day since 45 years.

Used to drink 2 bottles of palm wine for 20 years, currently stopped 10 yeras ago.

General Examination:

The patient was conscious,  coherent,  cooperative and well aware of surrounding place and time. 

Weight 53 kgs

No pallor 

No icterus 

No cyanosis 

No clubbing 

No lymphadenopathy 

No generalized edema

Vitals: 

Pulse rate : 78 bpm

Respiratory rate: 18 cpm