HK

John Smith, 01/01/1970 1234567 01 November 2024 **Diagnosis:** * Rheumatoid Arthritis, diagnosed 2018 **Clinical Phenotype:** Patient presents with symmetrical polyarthritis affecting the small joints of the hands and feet. Positive for rheumatoid factor and anti-CCP antibodies. **Relevant Medications:** Current medication: * Methotrexate 15mg weekly, subcutaneous injection * Prednisolone 5mg daily **Previous Rheumatology Medications / DMARDs / Biological Therapy:** * Adalimumab (Humira) - discontinued due to inefficacy * Leflunomide - discontinued due to side effects **Allergies:** Patient reports an allergy to penicillin, resulting in a rash. **Notable Comorbidities:** Patient has a history of hypertension, well-controlled with medication. Family history of rheumatoid arthritis in mother. Patient reports persistent joint pain and stiffness, particularly in the morning. Fatigue is also a significant symptom. **Examination findings** * Swelling and tenderness in the metacarpophalangeal joints. * Reduced range of motion in the wrists. * Slightly warm to the touch. **Investigations:** * Repeat full blood count, ESR, CRP * Rheumatoid factor and anti-CCP antibodies * X-rays of hands and feet **Assessment:** Chaperone was present during the examination. * Disease activity remains high despite current treatment. * Patient reports significant impact on daily activities. * Patient is keen to explore alternative treatment options. Examination findings * Swelling and tenderness in the metacarpophalangeal joints. * Reduced range of motion in the wrists. * Slightly warm to the touch. **Plan:** * Increase Methotrexate to 20mg weekly. * Consider switching to a biologic agent if symptoms persist. * Continue Prednisolone at current dose. * Referral to a rheumatology nurse specialist for education and support. * Review of current medications and potential side effects. **Follow up:** Follow-up appointment in 4 weeks. Dr. Hannah Khan MBBS, MRCP, Rheumatologist hkhan@ahdubai.com