A patient with joint pain

Dr. Praveen Weeratunga

History
• 22 year old
• Female
• Previously healthy
 History

2018 January 2018 May 2018 June 2018 June

L/S shoulder joint Recurrence of pain in the Weight loss of Admitted for
Inflammatory type pain R/S ankle joint and approximately 10kg evaluation
Over the next few weeks alternating buttock pain. Red eye with visual
she developed pain in Associated with blurring
B/L KJ and R/S Ankle backache Oral ulcers
joint
Treated with NSAIDS
Initial response noted
Also developed watery diarrhea with loose stools 2-3 times per day
without blood or mucus
History
• Past medical and surgical history – Nil of note
• Drug and allergy history – Nil of note
• Family history – Mother has psoriasis and is on treatment with MTX
• Social history
• From Jaffna, poor support when admitted to the NHSL
• Mother stays with her
• Father is a laborer
What are the key presentations in this patient?
• Discuss
Clinical approach – Joint pain
• Articular vs. Non articular
• Acute or Chronic?
• Inflammatory or non inflammatory?
• Pattern and number of joints involved
What type of joint involvement does she have?
• Discuss
Approach to diarrhea
• Chronic diarrhea
• Small bowel or large bowel???
Causes of small bowel diarrhoea
Extrinsic
Intrinsic
• Structural
• Infective
• Inflammatory/autoimmune
• Neoplastic
What is the most likely diagnosis?
• Discuss
Examination
General examination Abdomen
• Emaciated • Normal
• Pale
CNS
• No lymphadenopathy noted
• Normal
• No ankle edema
Cardiovascular MSS
• PR – 88/min, BP – 120/80, no • Tenderness and restriction
murmurs of movements of R/S SI joint
Respiratory
• Normal
What investigations would you request in this
patient?
Investigations
• FBC – Hb – 8.8, MCV – 110, WBC – Normal, Platelets – 320,000
• ESR - 120
Blood picture
Joint X rays
MRI – SI joint
Colonoscopy