rheumatoid arthritis with ckd ?

Male patient of 70 yrs admitted in general medicine department 
Occupation: labour work 
Chief complaints:
C/o fever since 10 days (high grade )relieved with medications 
Associated with chills and rigors mainly at night 
Swelling and pain in the hands,metacarpophalangeal joints ,knee joint ) 
He couldn't move and walk properly
History of present illness:
Patient was apparently asymptomatic 10 yrs back then he developed history of pain in joints
H/o trauma onto his middle toe 1 month back 
No h/o cough 
 h/o weight loss 
Decreased urine output
C/o Lower limb swelling since 1 yr 
Pedal edema with pitting type ( most prominent)
Negative history:
No history of asthma,TB,diabetes mellitus , epilepsy,CAD,thyroid disorders

History of past illness:
H/ o chronic use of nsaids abuse since 1 yr for joint pains 

Treatment history:
Not significant
Personal history:
Married
Occupation: labour work
Appetite : lost 
Mixed diet 
Micturition: decreased
Habits: smoking 
But stopped 10 yrs back
No known allergies so far

Family history:
Nill significant
Physical examination:
Pallor : mild 
Cyanosis: no
Dehydration: mild
Malnutrition: no

Vitals: 
Temp:101
RR:16/min
Bp:120/70
Grbs:90mg%
Oedema of feet : pedal edema upto knees 
Systemic examination:
Cvs: cardiac sounds (s1and S2 heard)
No thrills
Respiratory system:
Position of trachea Central 
Normal vesicular breath sounds
No wheeze and dyspnea
Abdomen:
No palpable mass
Can't palpate spleen and liver
No tenderness 
CNS :
Conscious
Normal speech 
No neck stiffness
Gait : slow with tenderness
At metacarpophalangeal joints right and left 
Dip + nt

Treatment medication plan:
He was on sodium carbonate 100mg 
Febuxostat 40mg 
Tramadol and acetaminophen
Pantop 
Chymo trypsin for a long time 
Trypsin 
Ultracet (bd) 
pitting type of oedema upto knee 
sweeling at (DiP) joint , metacarpophalangeal joint
mild pallor
ulcer at middle finger due to trauma 
swelling around knee associated with pain 



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