31 year old woman with polyarthritis since 2008

Patient name :   Xylocarpus736Moluccensis

Patient data (currently in hand written history and past reports) uploaded in summer 2015 by ArogyaUDHC social worker, Mr Kar from Mathabhanga

patient new images uploaded by kuldeep gupta (PICM & Research assistant) LNMC Bhopal.

Tabula Rasa (Global online health professional forum) processing on this case:

  • Michele Meltzer All I can tell from reading the record is the patient had rheumatoid arthritis, had a high sedimentation rate and is on medal 4 mg daily. As we discussed when I was in India, we try to avoid long term use of corticosteroids. Please give me more information.
  • Rakesh Biswas Thanks Michele, Yes this patient highlights some of the concerns around training that you have voiced in the past. Not only was she on high dose steroids for quite some time but also appears to be on Methotrexate 7.5mg daily for the last few years. I would have preferred it weekly. What is your practice on Methotrexate dosing and are their any trials to demonstrate superiority of one over the other (daily vs weekly in RA)? Clinically i evaluated her yesterday (Saturday) and she appears to have active synovitis even after all these years of treatment. Have ordered radiology hands for erosions. She also complains of nuchal pain and intermittent numbness (no focal neurodeficits though) and we are getting cervical spine xrays to rule out AAD.

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