case study

1. Submitted by : Aryan shah
III PHARM D
Department of clinical practice,
MALLIGE COLLEGE OF PHARMACY,Silvepura,Bangalore-90

2.  Rheumatoid arthritis is the most common systemic inflammatory disease, and is characterized
by symmetrical joint involvement.
 It is a chronic inflammatory disease that causes pain, swelling, stiffness and loss of function in
the joints .
 Being a systemic disease, it tends to affect other organs in the body.
 Extra-articular involvement including rheumatoid nodules, vasculitis, eye inflammation,
neurologic dysfunction, cardiopulmonary disease, lymphadenopathy, and splenomegaly are
manifestations of the disease.
 Usual disease course is chronic, some patients will enter a remission spontaneously (reoccurs
later).

3. SYMPTOMS
 Joint pain and stiffness of more than 6 weeks’ duration.
 May also experience fatigue, weakness, low-grade fever, and loss of
appetite.
 Muscle pain and afternoon fatigue may also be present.
 Joint deformity is generally seen late in the disease.
SIGNS
 Tenderness with warmth and swelling over affected joints usually
involving hands and feet.
 Distribution of joint involvement is frequently symmetrical.
 Rheumatoid nodules may also be present.

4.  Patient name : ABC
 Age : 57 years
 Sex : Female
 Weight : 92kg
 Height : 155cm
 Date of admission : 12-12-2017
 Date of discharge : 14-12-2017

5. COMPLAINTS ON ADMISSION
 c/o migrating joint pain, initially small joints
migraing from one joint to another(multiple) since
8months
 c/o swelling of involved joints

6.  Hypertension since 1year
PAST MEDICATION HISTORY
GENERIC NAME DOSE FREQUENCY TIME
T.CLINIDIPINE +
TELMISARTAN
1O/4Omg 0-0-1 After food

7.  Appetite : normal
 Sleep : normal
 Bowel and bladder : normal
 Diet : mixed

8.  B.P : 130/ 90mm Hg
 RR : 22 cycles per min
 Temp : Normal
SYSTEMIC EXAMINATION
 CVS : S1 S2 (+)
 CNS : conscious , oriented
 RS : NVBS(+)
 PELVIC ABDOMEN : SOFT

9. Rehumatoid Arthritis
Hypertension

10. LABORATORY TESTS
• WBC count : 1286 cells/cumm
• Neutrophils : 85%
• RF: positive
• ESR : 45mm/hr

11. Rheumatoid arthritis
Hypertension
ASSESSMENT
From subjective and objective evidence it is
confirmed that the patient is suffering from
Rheumatoid arthritis

12. To reduce the sign and symptom of the disease
To prevent the further complication of the
disease

13. DATE BRAND NAME GENERIC NAME INDICATION DOSE
(MG)
ROUTE FREQUENC
Y
TIME END
TIME
12-12-
2017
INJ RABEZOL RABEPRAZOLE PPI 2OMg IV 1-0-1 BF 14-12-
2017
12-12-
2017
T.NUCOXIA ETORICOXIB NSAID for
inflammation
60mg PO ½ - ½ AF 14-12-
2017
12-12-
2017
INJ ENBREL ENTANERECEPT TNF inhibitor 50mg S/C weekly AF 14-12-
017
12-12-
2017
T. RANCIL T CILNIDIPINE +
TELMISARTAN
HTN 10/40 PO 0-0-1 AF 14-12-
2017

14. PARAMETERS DAY1 DAY2 DAY3
BP (MM HG) 130/90 140/80 130/90
PULSE (BPM) 98 96 84
RR ( CPM) 22 22 22

15. BRAND NAME GENERIC NAME DOSE FREQUENCY TIME DAYS
T RABEZOL RABEPRAZOL 2OMg 1-0-0 Before food Continue for
30 days
T RANCIL CILNIDIPINE +
TELMISARTAN
10mg/40mg 0-0-1 After food To Continue
T CALPOL ACETAMINOPHEN 500mg BD or SOS After food To continue
INJ ENBREL ETANERECEPT 50Mg or
100mg
Once a week or
Severe pain
After food To continue

16. DRUG INTERACTION
All drugs were screened and no interaction was found

17.  ETANERECEPT – injection site infection,upper RTI,Headache,nausea
 TELMISARTAN –Diarrhea,headache,dizziness,URTI,myalgia
 RABEPRAZOLE – Constipation, abdominal pain,headache
 ETORICOXIB - Nausea, GI irritation, hyperkalemia,dyspepsia
 CILNIDIPINE – Nausea , headache,dizziness ,abdominal pain.

18. Do regular physical exercise
Take rest to relieve stress on inflammed joints
Put ice pack at pain and inflamed joint
In winter season use warm clothes at joints
Use warm water to reduce swelling
Increase the intake of turmeric
Take low protein diet
Reduce weight
Do easy tasks/movements
Take RABEZOL 30 min before food