Yu - Psoriatic arthritis (Hong kong)

Name: Yu Chang           
Sex: Male
Country: Hong kong
Age: 55
Diagnoses: 1.Psoriatic arthritis 2. Microcytic hypochromic anemia 3. Hypertension 1 level (High risk)
Admission Date: 2013-03-30
Days Admitted to Hospital: 30 days

Before treatment:
          The patient suffered a rash over the whole body 20 years ago, without any obvious reason. The abdomen, limbs and head were more severe. This was accompanied with pruritus. He went to the local hospital and was diagnosed with psoriasis. He used ointment for external use, but the effect was not good. The patient's right little finger, third finger and middle finger's end was damaged when he repaired a machine. He received resection and suture operation in the local hospital for the right little finger, third finger and middle finger's end. 6 months later, the wound was cured, but he suffered from swollen joints all over the body, this was accompanied with rigor and pain in the joints. He was diagnosed with Psoriatic arthritis by the local hospital. The patient received indometacin, methotrexate and sulfasalazine for treatment. Then the rashes all over the body disappeared. The swollen and rigor of joints throughout the body was alleviated. Before the treatment, the joints of the shoulder, fingertip, knee joints and ankle joints still had pain sensation. He felt pain and rigor if he kept a posture for a long time.

Admission PE:
          Bp: 130/86mmHg; Hr: 67/min. He suffered mild anemia. Through auscultation, the respiratory sounds in both lungs were clear, with no signs of dry or moist rales. The heart sounds were strong, the heart rhythms were regular, with no murmur in the auscultation valve area. The abdomen was soft, with no masses. The shifting dullness was negative. There was no edema in the lower limbs. The neck had obvious muscle pain when he turned the head to the left side. The swivel range of the left side was reduced. If he stayed in the sitting position for too long there was obvious stiffness of the knee joints and arthralgias. When he stayed in the recumbent position too long during the night and he had obvious pain in the whole body after getting up. There was obvious pain in bilateral shoulder joints, wrist joints, interphalangeal joint, ankle joints and metatarsophalangeal joints. The movement of both shoulder joints was limited. The arms could only raise 90 degree. There was mottling brown hyperpigmentation in the abdomen, back, the four limbs and head. There was pink patch ring skin rash in the right inner thigh, head rest and back, the diameter of the rash was about 1cm. This was accompanied with obvious pruritus. The skin in the four limbs was dry.

Nervous System Examination:

          Yu was alert and his speech was clear. His memory, calculation abilities and orientation were normal. Both pupils were equal in size and round, the diameter was 3.0 mms, and the pupils had normal reactions to light stimuli. There was no nystagmus. Both eyeballs had normal movement. The forehead wrinkle pattern was symmetrical. The bilateral nasolabial sulcus was equal in depth. The tongue was in the center of the oral cavity. The muscle tone of all four limbs was normal. The muscle strength of all four limbs was level 5. The tendon reflexes of all four limbs were reduced. The abdominal reflexes could be elicited normally. The coordinate movement was normal. Bilateral palm jaw reflex was negative. The pathological sign of both lower limbs was negative. There were no signs of meningeal irritation. The laboratory test showed: hemoglobin 102g/L.

          Yu received treatment in order to expand the blood vessels, nourishment for the neurons, treat anemia and regulate the immune system. He also received treatment for cell repair and cell regeneration. This was accompanied with rehabilitation training.                          

          The muscle pain in the neck is obviously alleviated when he turns to the left side. The range of turning on the left side has increased. The rigidity and pain of the knee joints is obviously alleviated when sitting for a longer time. The pain in the whole body is obviously alleviated after getting up in the morning. There is no obvious pain in the right shoulder, both wrist joints, both ankle joints and all interphalangeal joints in the daytime. The pain in the left shoulder is obviously alleviated and only has a slight pain. The patchy ring pink rash in the inner right thigh, head rest and back has faded away. The itch sensation is obviously alleviated. The degree of dry skin on the four limbs is alleviated. Control of the blood pressure is better and the blood pressure is stable. The anemia was cured and the hemoglobin level is raised and reached 123g/L.



Dear Dr. Zhao,

Thank you for your reply.

I got my blood tested yesterday to confirm if I am G6PD. I will know the result next week and will let you know once this is in hand.

1. I am pleased to say that I am 90% better than I visited your clinic.

The balance 10% is basically the pain at all the finger joints which still cannot fully folded or bend. There are still slight swellings at all the middle joints.

I massage it regularly and bend it fully at least 2 times a day. I am hoping that this remaining 10% will go away. But until today the pain and (slight) swellings at the finger joints are all still there.

I have pain also at my wrist joints, especially the left hand wrist joint.

I am hopeful that the above pain will disappear in time with my constant therapy of bending and stretching it.

Thank you.

Jack (Yu Chang)

 Date: 2014-11-01

Dear Dr.,

How are you? I trust you, Dr. Liu, Dr.Wu and all the doctors are doing well.
I have finished all my medication and I am fine, except sometimes I still have minor pains in my joints, i.e. elbow and ankle.
I wonder if there is a need for me to continue to take any further medication to improve my healthier condition. My Rheumatologist continue to prescribe Indomethacin for me to suppress the inflammation. 

All the medication you prescribed to me before, such as Donepezil, Prednisone, Mecobalamin, Azathioprine have finished. Shall continue to take them?

I will appreciate your suggestion.

Thank you.

Jack (Yu Chang)

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