42 yr female comes with swelling on both ankles since from last one year.in investigation uric acid,rft,lft,cbc all r in normal range.in treatment give lyser d tds nd b complex nd in between light steroid also added..but does not improved. .give the right advise

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I think patient is overweight which causes achilies tendenopathy Need to icing,ultrasound and heel silicon cushion

Yes u r right...she just needa to resuce weight in that area
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Do TSH and 2DECHO

Rule out hypertension and amlodipine intake. If it's just b/l ankle edema can be a case oligoarthritis-in such scenario intermittent steroids won't work ,you need to give regular steroids in adequate dose at least for 6 to 8 weeks before tapering.Aspirin r paracetamol is a better option for symptomatic pain relief avoid diclofenac which itself can cause edema.Have you checked her RA factor n CRP status?

Rule out Hypertension - electrolyte imbalance, can also check TSH

bilateral doppler

Have she has hypertension? And then taking ca chanel blokers?

Two major dx can be gout/kidney dysfunction and vericose veins if RFT is normal then go for vericose vein Colour Doppler B/L lower limbs can be done

Check out h/o HTN as some anti hypertensive drugs also cause pedal edema
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Fasting lipid profile,ECG and HCCT chest should be done.Pointing towards CCF

Inv ECG ECHO Rule out any drug history

is it pitting oedema???

no..its non pitting
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