Dr Shrenik Shah Shrey hospital Diagnostic dilemma Dr Shrenik Shah Shrey hospital

Case history Male/58, busy Paediatrician Musculoskeletal pains of chronic duration-neck pain, LBP, knee, ankle, shoulder, elbow, wrist pains and extensor tenosynovitis of left hand h/o of chikungunia No medical illness in past Treated with NSAIDs and allopurinol with partial relief Investigations normal except transient rise in serum uric acid

Clinical pictures

Shoulder Xrays

USG SHOULDER

Xrays

IS IT GOUT? S URIC ACID Clinical picture of joint pains of unexplained etiology Clinical response to NSAIDs and/or allopurinol? Xray  arthritic changes

Gold standard Aspiration and demonstrated crystals If negative revise the diagnosis JAPI-feb 2011- Post-Chikungunya Chronic arthritis-our experience with DMARDs over 2 yr f/u

Post chikungunya chronic arthritis (PCCA) Onset- febrile polyarthritis H/o affection of multiple family members DIP joint involved Typical soft tissue pain Edema hands and feet Seronegativity in majority Synovial biopsy- nongranulamatous chronic synovitis JAPI-feb 2011- Post-Chikungunya Chronic ar-our experience with DMARDs over 2 yr f/u

PCCA Treatment NSAIDs for symptom relief Low dose steroids – for control of synovitis and edema of hands and feet HCQ and SSZ combination MTX added- majority showed good improvement JAPI-feb 2011 PCCA -our experience with DMARDs over 2 yr f/u

RESULT