A female patient aged 59, known diabetic since 5 yrs on oral medication, presently on Metformin 2 BD, known hypertension for 10 yrs, on oral tab.nicorandil.od, known hypothyroid since 13 to 15 yrs & on tab. Levothyroxine 100 UG before, now 50 UG. She had the hysterectomy for cervicitis in 2000 and neuropathy since 25 to 30 yrs. She is taking oral methyl cobalamine 1500 ug od. In between inj.of same twice or thrice for a month. Presently, 2 months back she developed stiffness & pain at right elbow & shoulder & difficulty in doing work.
But blood reports & x-ray were normal.physiotherapy suggested. Since last week she developed stiffness & pain at almost all joints, swelling at both wrists, hands, ankles, feet. She is not able to sit, stand, lift from bed handling objects on her own. X-rays of all joints normal, no erosion, no degenerative changes. RA factor -ve.blood urea, serum…
