28 yrs old female with lower back pain since 2 days

 C/O pain in Left lower region since two days insidious in onset, pricking type of painRadiating pain ( radiating to friend sign to lower abdomen)Since two days

Nausea and vomiting since two days

Non-projectile,  aggravated on  intake of food and water 

No history of decreased or increased urine output, Burning micturition

No is your fever

No history of diarrhoea

No history of headache, giddiness

Tightness in abdomen since two days

History of intake of spicy foods 2 days back

Menstrual history – regular  3/25

Uses 2 to 3 pads per day, not associated with pain abdomen, lower back pain

Past history-

Not a known case of diabetes mellitus, hypertension, thyroid, asthma, TB

History of drug intake for joint pain- wysolone,naproxen 250 mg

History of joint pain since 45 years

History of C-section four years back

P2L2A0 —>2nd delivery-C section with 1.5 years space

No history of comorbidities

No history of any hospital admissions 

GENERAL EXAMINATION:

Patient is consious, coherent, cooperative 

Vitals:

Temperature : afebrile

RR: 20 cpm 

Bp: 120/80

HR: 85 bpm

Spo2: 100%


No signs of pallor, icterus, clubbing, cyanosis, lymphadenopathy, edema.

Systemic examination:-

CVS-s1s2 heard

Rs- BAE +

CNS- no focal neurological deficit

P/A- soft, non tender






Investigations






Diagnosis:- known case of sero positive RA

Treatment:-
Tab. Methotrexate 7.5 mg po/od( once a week)
Tab folic acid 5 mg po/od






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