A 26 years old female patient, post partum, delivered 4 months back, has complaint of pain multiple small joints of hands mainly PIP joints, wrist, elbow and ankle n knee. Complaints of morning stiffness. No rash, no nail changes. No other complaint.
Has hypothyroidism on thyroxine 12.5mg. Euthyroid now on thyroxine. Has hb 11.5, Esr 40, Tsh 0.77, Rheumatoid factor negative , Anti ccp negative, ANA 1:40 ( positive) , Vitamin d -56 (adequate); on examination no tenderness, redness or any sign of inflammation on joints. Suggest diagnosis n treatment.
