[John Smith, DOB: 12/03/1960]
**Diagnosis**
* Rheumatoid Arthritis
* Osteoarthritis
**Relevant Past Medical History**
You have a history of hypertension, which is well-controlled with medication. You also had a total hip replacement five years ago.
**Relevant Medications:**
* Methotrexate 15mg weekly
* Prednisolone 5mg daily
* Amlodipine 5mg daily
* Allopurinol 100mg daily
**Progress Since Last Visit**
You report that your rheumatoid arthritis is reasonably well-controlled, with some morning stiffness lasting approximately 30 minutes. You have experienced some mild side effects from the methotrexate, including nausea, which has improved with the addition of folic acid. You are concerned about the long-term effects of prednisolone.
**Examination**
Examination revealed mild swelling in the left knee with tenderness on palpation. Range of motion was slightly limited in both knees. There was no evidence of active synovitis in other joints.
**Relevant Labs**
Recent blood tests showed a Hb of 13.5 g/dL, WCC 6.2 x10^9/L, Platelet count 280 x10^9/L, Creatinine 85 umol/L, GFR >60 mL/min/1.73m2, ALT 25 U/L, AST 22 U/L, GGT 28 U/L, Albumin 42 g/L, and Calcium 2.3 mmol/L.
**Relevant Imaging**
* X-rays of the knees showed mild osteoarthritic changes.
**Joint Injections**
Injection of 40mg Depomedrone into the left knee. John has been advised about the usual risks of joint injection and to rest for 48 hours post injection.
**Conclusions**
Your rheumatoid arthritis is reasonably well controlled on your current medication regimen. We will continue with the current treatment plan, but I will consider a reduction in the prednisolone dose at your next review. I have discussed the risks and benefits of your medications with you. I have also discussed the possibility of switching to a biologic agent if your symptoms worsen.
**Review Arrangements**
We have scheduled a follow-up appointment in three months to review your progress and assess the response to treatment. I have advised you to contact your GP if you experience any new or worsening symptoms.
