HF Henry Ford Medical

MEDICATIONS:

1.  Enbrel (start date September 2006) 25 mg twice weekly.

2.  Prednisone 7.5 mg daily.

3.  Actonel.

4.  Allopurinol 300 mg a day.

5.  Glipizide 5 mg a day.

6.  Lipitor.

7.  Plavix.

8.  Plaquenil 200 mg a day.

9.  Darvocet-N 100 p.r.n.

CHIEF COMPLAINT:  “I feel okay.”

HISTORY OF PRESENT ILLNESS:  Patient’s pain in her right groin and thigh has eased.  She notices partial relief with the use of naproxen sodium 220 mg taken on an as needed basis.  Patient has pain in her right knee from time to time with weightbearing activity.  That pain is moderated by rest.

REVIEW OF SYSTEMS:  No weight loss, no cough or shortness of breath.  No injection site reaction associated with Enbrel.

PAST MEDICAL HISTORY:  See my note of January 25, 2008.

EXAMINATION:

VITAL SIGNS:  Weight is 202 pounds, blood pressure 119/67, with a pulse of 67, temperature 98.8.

MUSCULOSKELETAL:  A complete peripheral joint evaluation for swelling, tenderness on palpation, limitation of motion was performed today.  I found no swelling in the knee, PIPs, or the MCPs today.  No swelling in the wrists.  No nodules at the elbows.

EXTREMITIES:  In the lower extremity, no pain with range of motion of the hips.  There is valgus deformity of both knees.  Right knee is warm to touch when compared to the left.  There are no anterior knee effusions.  No pretibial edema.  No squeeze metatarsal phalangeal joint tenderness.  Joint count swelling and tender today is 0 respectively.

IMPRESSION:  Rheumatoid arthritis with no evidence of inflammatory activity today.

MEDICAL DECISION MAKING:  Patient will continue with her current antirheumatic regimen.