{"text":"| \n\u2018 Acute Services Division . . T NHS \n-OUTPA-TIENT: 18\/08\/2015 at Stobhill General Hospltal \n\" FOLLOWTUP: ., Discharged \u2018 \n2 \n: EmergencyCare\"ar\\ld R L o b\\fd \nMedical Services Directorate ) : . Greater-Glasgow \n: and Clyde \n,Cons'UItanis: R o Rheumatology Department \nDr Arine McEntegart o \u2018 \u2018Stobhill Hospital \nDr Hilary Wilson . 133 Balornock Road \no T . \u00ab Clasgow \nv o e G21 3UW . _ \n. \u201c . . \u2019 .Enquires to:\u2018C'hfistine Dank_s\/Rhon_a \\-Nyper (Secretary) \n-t ' . DirectLine: 0141800 1908 \n' \u2018 f ' Fax No: :0141 211 1120 \n24 August 2015 ' L : \n* Ref:RW \nDRESTAFFORD \nKILSYTH COMMUNITY HEALTH CENTRE \nAIRDRIE ROAD \nKILSYTH \nG65-9JE \n-Dear Dr Stafford . \n| AGNESCLELLAND \" DATEOF BIRTH: 08\/09\/1955 . \nU . CHI NO: 0809555328 \u2019 \n39 RENNIE ROAD KILSYTH, GLASGOW, LANARKSHIRE, G65 9PQ R \nDIAGNOSES: Osteoarthritis, Type II dlabetes mellitus, Chronic fatigue . \u00b0* \nTHERAPIES:. . Celecoxib 200, mg b.d. , Gabapentin 300 mg t.i.d., Amitriptyline 10 mg nocte, \n: Salbutamol, Symbicort inhalers, Fluoxetine, Aspirin, Ramipril, GTN, Omeprazole, \nAtorvastatin, Isosorbide mononitrate, Co-codamol, Diitiazem, Metformm \nMany thanks for refernng thlS 59 year old. lady to the rheumatology clinic for assessment. She tells \nme she has had w1despread joint pains *for over ten yearsnow. She has had to give up her job as a \nCleaner a few years ago. She describes pain in the hands, wrists, neck, low back, knees and feet. \nShe does describe some morning:stiffness in the hands. Shehad no'sero negatlve associations or \nconnective tissue disease features. Tnote that you tried to change her away from Celecoxib because \nof your concern about cardiovascular risk but she finds that this is the only medication which helps. \nOn \u2018examination she appeared well but overweight at 94 kgs against a height of 1.65 metres. Blood \n~pressuie 110\/73 mmHg. Musculo-skeleltal examination revealed early multinodular osteoarthritis \n1n the hands with no'synovitis or tenosynovitis. Wrists and elbows.move freely. There was slight \n_ restriction of capsular movements at the shoulders. Lower limb.examination revealed sllght \nlimitation of movement at.the hips, cerv1cal \u2018and lumbar spine movements were moderately \nrestricted. . o \nPrev1ous x-rays have con\ufb01rmed osteoarthrms inthe \u2018hands and the- hips. Previous 1mmunology was \nnegative and m\ufb02ammatory markers earlier this year were normal \n. I have explained to Agnes that I.would agree with the diagnosis of osteoarthritis. T have suggested \n\u201cin my handwritten note that we try switching her Celecoxib to Naproxen 500 mg b.d. but with \n- increased PPI cover in the form of Omeprazole 20'mg b.d. 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