things u will ask from a patient who has rheumatoid arthritis

1. ask them to make namste with flexion and extension at wrist joint, ask
them to make a fist, ask them to button and button their shirt, ask them to
hold object with their hand , ask them to pick up any coin or any thing from
surface see if they are able to do that. that will assess severity of their
disease .
in this video the patient is asked to increase the dose of methotrexate and to
be started on some nsaids, but the patient says that she has gastric problem
and she can not take ibuprofen, and neither can she take more methotrexate
as she has liver problem, this question is dealth with by him with the answer
that there are some other modalities of treatment like antibodies, but not
everyone can get this treatment as, they have to do some blood tests to be
ascertain that the patient qualifies for those type of medicines.

you should always addresss patient questions...like in this case she is asking
whether rhumatd arthiris can be cured.... so she should be told that it can not
be, but symptoms can be controlled.
rh.arthis is bilaterally symmatrical deforming arthrpathy, involving
metacarpophalngleal , interphalyngeal jts, and wrist joints, knee joints, and
metatarsophalyngeal joints. there can be ulner deviation, intersseous muslce
wasting.
focus hx on joint pain, morning stiff, functional disablity , extra articular
findings, pattern of joint involvement. exam should see deformity of joints,
active synovitis, functional disablity.

questions to start in pt with rh. arthirits

do u want to tell me problem with the hands
has she problem with the hands before or its something recent
to ascertain joint involvmnt , he is askig u hav pain on knuckles, when they
say yes, he asks if she has pain also on interphylgeal joint by pointing out
''here u have pain''
when the patient tells about stiffness, u need to ask when they are stiff, and
for how long they are stiff, and does stiffness resolve.

as there is blue colour in the finger, so he asks , does fingers change colour,
from navy blue to white or soemthing....he is ascertaining that the patient
has ranauds phenonmenon
...how she is coping ? does she need help in doing things.
ask about other medical problem.
ask about rash, eye rednesss, any bowel symptoms, no back pain ? u need to
look at the medication for other medicines. and ask if these are enough for
pain, or she needs more....
check sore areas of joints, ask for permission and be gentle, ask patient to
flex...
to ascertain functionality of hands...ask i would like to know how much u can
do with your hands, then ask them to do namste up and down at wrist joint,
ask them to clench fist, do pincer action ,and try to separate pincer, ask them
to pick up coin, see if she can button and unbutton shirts.
tell them if u had more time u will do extraarticular symptoms.
at the time when the examiner says u have two minutes u hav to explain to
the patient what their prblm is , address their concerns, ask them what u will
do in terms of blood tests and y u will do, and which treatment u will start.
important points. only disease which can present like rhum art is sle joint
disease, but erosive arthritis is feature of rheum arthritis.