60yr old female thin built complains of swelling, pain,restriction of movts over soft tissues of foot forearm elbow asymmetrically lasting for a few months every year. Initially symptoms disappeared completely but now this seems to continue persisting . There is no history of tb,htn,dm or any other signif past illness,no ho loss of wt. On exam pallor+, tenderness,swelling ,raised temp+ over affected areas.in investigations hb 8.5, crp 77 iu, esr 30,ra factor -ve, ana - ve, uric acid normal., rest hemogram normal.
Tt given antiinflammatory drugs, prednisolone, antibiotics, hcqs for 1 mth. Was responssive to short course of steroids initially but not now.
Kindly advice further. I would be grateful.the lady is my mother , i m a pediatrician working in indian railways. Thanks a lot