Hypertension and diabetes...

A 71 years old woman, with H/o hypertension and diabetes mellitus visited the clinic with complaints of on and off bilateral knee pain for the past five years. She was diagnosed with osteoporosis and given analgesics and physiotherapy, but it did not relieve her pain. Her pain score was 6-8/10, with severe in the morning. Bilateral knee joint stiffness was seen.

Her vital signs were stable upon examination, and both knees showed a standard range of movement with tenderness. There was no effusion, and both tendon and ligaments stability tests were regular. Investigation reports indicated higher Rheumatoid factor, ESR and anti-CCP levels. Her knee X-rays showed joint space narrowing, soft tissue swelling and periarticular erosions indicating rheumatoid arthritis.