The document presents a case study on a 40-year old female patient diagnosed with rheumatoid arthritis. Key details include: - The patient presented with complaints of breathlessness and chest pain on the right side. - Her medical history included rheumatoid arthritis for 6-7 years and use of medications including a corticosteroid inhaler. - On examination, her pulse was 80 bpm, blood pressure was 170/110 mmHg, and oxygen saturation was 74%. - She was assessed and diagnosed with rheumatoid arthritis. Her treatment plan included medications like an antibiotic, calcium supplement, corticosteroid, and disease-modifying drugs over 3 days. - Her treatment was to be monitored for

1. A Case Presentation on
Rheumatoid Arthritis
Presented by : Renuka Atul Bari
T.y. Pharm.D roll no. O2
Guided by : Dr.P.R.Chavan
Assistant professor and HOD
Department of Pharm D
MAHATMA GANDHI VIDYAMANDIR’S
PHARMACY COLLEGE, PANCHAVATI ,
NASHIK.
Affiliated S.P.Pune University,Pune.Approved by A.I.C.T.E., Pharmacy Council of
India, New Delhi and DTE Mumbai.

2. SOAP ANALYSIS

3. Subjective Data
• Patient Name : XYZ
• Age: 40 years
• Gender: female
• Cheif Complaints: Breathlessness since 3-4 days, Chest pain on right
side

4. Past history
• History of Rheumatoid arthritis since 6-7 years
• Social history :- No history of addiction
• Mediciation History : Aercort pump inhibitor
• Social History : NA

5. Objective data
• General Examination:
Pulse rate: 80b/min
Blood pressure:170/110Mmhg
CVS: S1& S2 normal
Spo2 : 74% on RA
CNS : Conscious oriented
P/A : Soft non tender.

6. Standard treatment chart

7. Assessment
• On the basis of subjective and objective information patient was
diagnosed Rheumatoid Arthritis .

8. Treatment chart
S.No. Brand Name Generic Name Dose Frequency Duration
1. Inj.Clavam Clavunic acid 1.2mg BD 3days
2. Inj.Amlo Amlodipine 10mg Stat 3days
3. Tab.Musinac musinac 600mg TDS 3days
4. Tab.Telma Telmisartan 400mg OD 3days
5. Inj.Theophylli
ne
Deriphyllin 2cc SOS 3 days
6. Inj.H.Cort Hydrocortisone 100mg SOS 3days
7. Tab. Calcium Calcium carbonate 400mg OD 3days
8. Inj.Pipzo Piperacillin + Tazobactam 10ml TDS 3days
9. Tab.Aldacton
e
Spironolactone 50mg BD 3days

9. Inj.Clavunic acid1.2mg iv b.d
• Brand name: Clavam
• Class : Penicillin
• MOA : It inhibits nucleic acid synthesis by forming nitrous radicals
which disrupts the DNA of microbial cells.
• Uses: Treatment of bacterial infection , skin abscess , erysipelas etc.
• ADR: Rash , Lose stool , Vagnitis , Dipper rash , anemia etc.
• Contraindiacation: contraindicated with BCG vaccine & typhoid
vaccine
• Std.Dose: 5ml

10. Inj.Amlo 10mg iv stat
• Brand name: Amlodipine
• Class : Calcium Channel Blockers
• MOA : Inhibits transmembrane influx of extracellular calcium ions across
membrane of myocardial cells.
• Uses : In HTN , Angina , Coronary changing serum calcium concentration.
• Contraindication : Hypotension
• Adv.effects : Muscle cramps , male sexual dysfunction etc.
• Std.Dose: 5mg , 10mg

11. Tab.Musinac 600mg oral Tds
• Brand Name: Musinac
• Class : Mucolytics
• MOA:That works by thining & loosening phlegm in the lumen
windpipe & nasal passage thereby making it easier to caught out
phlegm
• Uses : Used in airway disease such as bronchilits , emphysema etc
• ADR: Headache,Nausea,Vomiting, Stomach pain,Diarrhoea
• Contraindication:If you are allergic to pantoprazole or other
ingredients of Pan 40 tablet.If you are allergic to similar medicines
like omeprazole, etc.If you are currently taking anti-HIV medications
like rilpivirine or atazanavir.
• Std Dose: 600mg

12. Tab.Telma 400mg oral
• Brand Name: Telmisartan
• Class : Angiotensin II receptor antagonist.
• MOA: It works by blocking action of a hormone called angiotensin 2 in the body
that causes narrowing of blood vessels leading to high BP .
• Uses: HTN , heart failure , Stroke , Heart attack etc.
• ADR: Back pain , Upper respiratory tract infection , sinus infection etc
• Contraindication: Pregnant lady
• Std. Dose: 4mg , 40mg , 12.5mg

13. Inj.Deriphyllin 2cc iv sos
• Brand name: Theophyllin
• Class : Bronchodilator
• MOA : Relaxes smooth muscle located in the bronchial airway & pulmonary
blood vessels
• Uses: It is commonly used for the diagnosis or treatment of Asthma Copd etc
• ADR: skin rash,wheezing,tightness in chest,Trouble breathing
• STD Dose : 2ml
.

14. Inj.H.cort 100mg iv sos
• Generic name : Hydrocortisone
• Class : Corticosteroid
• MoA : Help to Relieve redness , itching , swelling or other discomfort caused by
skin condition.
• Uses : Cancer , piles , Asthma , Rhematoid arthritis etc
• Adv.effects : Stomach Upset , Mood changes, weight Gain etc.
• Contraindication : T.B. , D.M. , Herpes simplex virus infection
• Std dose : 100mg

15. Tab.calcium 400mg oral od
• Generic name : Calcium carbonate
• Class : Calcium salts
• MOA : Prevents or treats negative Ca balance ; oral Ca supplements may protect
against renal calculi formation by chealting
• Indication : Relieve heart burn , stomach upset , hyperphosphatemia etc.
• ADR ; Anorexia , flatulence , hypercalcemia etc
• Contraindication : In combination with ceftriaxone risk of potentially fatal
particulate prescription in lungs
• Std Dose : 400mg , 500mg , 750mg

16. Inj.Pipzo 10ml tds iv
• Generic name : Piperacillin + Tazobactam
• Class : Penicillins
• MOA : Antipseudomonal penicillin plus beta lactamase inhibitors
biosynthesis of cell wall mucopeptide synthesis by binding to one or more
of penicillin binding protein & is effective during active multiplication stage
• Uses : Intra abdominal infection , Nosocomial infection , Community
Acquired pneumonia
• ADR : Diarrhea , Dyspepsia , Pruritis , Hypertension etc.
• Contraindication : Allergy to pencillins , cephalosorins etc.
• STD Dose : 2g/250ml vial 2.25g , 3g/375mg vial3.375g etc

17. Tab.Aldactone 50mg oral bd
• Generic name : Spironolactone
• Class : Diuretics
• MOA : Competitve binding of receptors at aldosterone dependent Na-k
exchange site in distal tubules results in increased excretion of Na+ , Cl- &
Water retention of k+ & H+
• Uses : Hypertension , Congestive heart failure , Acne , Hypokalemia etc.
• ADR : Urticaria , Thrombocytopenia , Vasculitis , Hypertension etc
• Contraindications : Hypersenstivity , addition disease or other condition
associated with hyperkalemia
• Std dose : 25mg , 50mg , 100mg

18. Planning
• Discharge medication : Patient not yet discharge
SHORT TERM GOAL: To provide symptomatic relief from fever, cough
and Pain in abdomen.
• To provide symptomatic relief from pneumonia.
LONG TERM GOAL: Eradication of the offending organism and complete
clinical cure are the primary objectives.
• Associated morbidity should be minimized.
• To decrease the mortality.
• To improve quality of life.

19. Monitoring Parameters
• Changes in possible side effects.
• Monitor to the changes regarding to the joints
• Patients must be monitor if any inflammatory parameters are affect.
• Further tests like chest x-ray ray , CT scan etc. must be done to see
condition of the patients etc.

20. Point to physician
• Tab.spironolactone should be given by monitoring properly because it may
increase risk of hyperkalemia
• Inj.pipzo may caused hepatic & especially hematopoietic functions due to
prolonged treatment is should be monitor.
• Tab.Telma should be given in prper dosage or avoid because the risk of fetal or
nonnatal morbidity in pregnancy.

21. Point to Patient
• About disease: Rhematoid Arthritis is a chronic & usually progressive
inflammation disorder of unknown characterised by polyarticular symmetric joint
involvement.
• About Drug : Inj.pipzo may cause skin reaction or irritation so don’t be afraid.
Tab.Amlo may lead to muscle cramps also.
Medication should not be missed as it can worse the condition and may lead to
other problems.

22. • Lifestyle modification :
Regular physical activity like walking , swimming, cycling can help to
prevent effects
Do heat & cold therapy to reduce pain and swelling in joints. Hand
exercise like slowly curling the fingers wide on a table & squeezing a
stress ball can all help increase strength & fexiblity in the hands. Rush
Travelling must be avoid it may lead to increase in pain also
• Dietary Factors :
Addition of Fish oil richs in omega 3 fatty acids such as fish, walnuts,
almonds,olive oil etc. Avoid to eat junk food or Pack food. Eat fresh
vegetables & Fruits like custard apples, chikus, grapes, oranges, apple
etc. Milk liquid, Lassi, Ghee,etc. should consume.
Avoid food like Spinach, Sweet potatoes, Beans etc. because it prevent
calcium absorption. Avoid consumption of caffeinated products.

23. Reference
• Tripathi.K.D.(2018),Essentials of Medical Pharmacology 8th Edition,Pub.By
Jaypee Brothers Medical, P.g.No.766-769.
• Wells Barbara, Dipiro Joseph Schwinghammer Terry, Cecily Dipiro,
Pharmacotherapy Handbook, 7th Edition , pub.by Megraw-hil Company,
PgNo.31-41
• Drugs : View Uses, Side effects , Prize and Substitutes. Available From :
amoxicillin/clavulanatehttps://reference.medscape.com/drug/342474?src=mbl_
msp_android&ref=shareSent using the Medscape App for Android™

24. THANK YOU