Patient presentation
Chief complaint: Polyarticular joint pain and morning stiffness for 18 months. Worse in the morning, improves with movement but never fully resolves. Symmetrical involvement of hands, wrists, knees.
History: Symptoms started gradually. Initially attributed to "ageing" but progressed. Patient is a school teacher; difficulty writing on blackboard. Tried OTC ibuprofen with partial relief. RA factor positive on testing. Anti-CCP positive. ESR 64, CRP 22. Started on methotrexate 7.5mg/week 4 months ago — partial improvement, still significant morning stiffness >2 hours. Wants to add Ayurveda. No comorbidities. Periods irregular last 6 months.
Your Assessment (self-test)
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