63F Urinary incontinence 4 years ,RA on DMARD 25 years
 A 65 year old Hindu woman a housewife a resident of west bengal having a Bsc degree and belonging to middle class according to modified kuppuswamy scale presented to the general medicine OPD with  chief complaints  of  -constipation since the past 3 years  -continuous dribbling of urine since the past 4 years    History of presenting illness   Patient was apparently asymptomatic 26 years ago  , when she developed continuous dull aching pain in both the knee joints , which was exaggerated in the mornings and was bearable throughout the day , it was aggravated on walking and relieved on rest  associated with redness around the knees no history of trauma no history of evening rise of temperature  no history of cosmetic deformity(varicosity, skin discoloration) -she underwent a bilateral knee replacement for knee stiffness  -is on DMARDS since 25 years  patient was incidentally diagnosed with hypertension 20 years ago  during a follow ...