She was continued on methotrexate and her prednisone was stopped. lungs as well as the center also to loss of life even. However, diagnosis could be elusive particularly if the normal diagnostic criteria aren’t meet or there is certainly absence of regular scientific features (2). This case record will concentrate on an older woman with an extended background of bilateral leg joint discomfort that was afterwards diagnosed as arthritis rheumatoid and subsequently began on disease changing medications (DMARDs). Case Record A 71 years of age woman, with root diabetes and hypertension mellitus, emerged on her behalf normal follow-up in a country wide federal government major treatment center. At this go to, Rabbit Polyclonal to 14-3-3 that was her second go to using the same doctor she noticed the last period, she complained of on / off bilateral leg discomfort for days gone by five years. She got seen various personal general professionals who got diagnosed her as bilateral leg osteoarthritis and recommended her with analgesics aswell glucosamine and physiotherapy. Nevertheless, this didn’t relieve her from the discomfort that triggered her obvious problems in strolling. She referred to her discomfort rating which range from 6C8/10 with worse discomfort in the beginning of the time and small improvement as the day wears off. There was occasional blateral knee joint stiffness but no obvious swelling. On examination, her vital signs were stable. Examination of both knees showed normal range of movement with tenderness at joint line. There was no effusion, and both tendon and ligaments stability tests were normal. Looking at the chronicity of her problem especially with just minimal improvement with the current treatment plan, she was subjected to X-ray of both knees along with connective tissue screening profile that included erythrocyte sedimentation rate, C-reactive protein (CRP), anticyclic citrullinated peptide (anti-CCP), antineutrophil cytoplasmic antibody (ANCA) plus antidouble stranded DNA antibody (anti-dsDNA) and rheumatoid factor (RF). She was given an appointment of two weeks. At two weeks, she returned with all her investigations ready. Her RF Alizarin was high at 67 IU/mL while her ESR and anti-CCP were also elevated at levels of 78 mm/hr and 47 u/ml. Her knee X-rays showed typical features of rheumatoid arthritis such as joint Alizarin space narrowing, soft tissue swelling and periarticular erosions. Other Alizarin investigations were normal. She was treated as rheumatoid arthritis and started on a low dose prednisolone as bridging therapy concurrently with methotrexate, taking into account that her liver function test so far was normal. She was given an appointment of another 2 weeks where an improvement in pain scoreed from 6C8/10 to a current score of 1C3/10 was noted. She was continued on methotrexate and her prednisone was stopped. She was advised to return every 3 months to monitor her liver function test as hepatotoxicity since liver fibrosis are known side effects of methotrexate. Discussion Rheumatoid arthritis is usually diagnosed based on 2010 American College of Rheumatology-European League Against Rheumatism (ACR-EULAR) Classification (3). In this classification, a score of 6 or more usually indicates a definite rheumatoid arthritis (RA) while a lower score indicates a lower likelihood of that condition being RA. This classification includes features such as duration, involved joint type, i.e., large or small joints and raised serology markers Alizarin such as anti-CCP, RF, ESR and CRP. Based on this classification, this patient would rank in a score of only 4 which then was needed to be correlated with other features such as classical X-ray findings as noted to be present in this patient to diagnose the presence of RA. Therefore, diagnosis of RA can be a challenge, especially when scores of less than 6 are obtained on the gold.