A rare side effect of widely used drugs

Genie presents with abdominal pain and intermittent constipation. Is her rheumatoid arthritis to blame?

Genie is 68 and has been seeing you for some years.

Senior woman stomach ache

She has rheumatoid arthritis (RA) for which she takes diclofenac 50mg on occasion — up to three times a day as needed, for up to a week, perhaps every few months.

She has not needed disease modifiers, and she has never taken prednisone.

Genie is otherwise well and is the principal carer for her mother who also has RA.

For several months, she has had tiredness, lethargy and abdominal pain.

She describes

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