<s>[INST] sir my aunt got pain in hands with swelling on goin to doc she cam to her bp 160 by 100 she took analgesics for pain and salt restriction diet now she developed pain and swelling in both foots and stiffness of neck ,pain relievs by evening , she had chickengunia 1 year back ,her hb% is 9g/dl ... what may b the cause [/INST] Hello, As your aunt has a past medical history of chikungunya, there will be some post pathological effects of the disease. Swelling, pain, tiredness, muscle weakness, joint inflammation are common. Having a drug prescription for symptom relief will be of advice. Also, as for chikungunya, the patient tends to have muscle weakness by which the joint space reduced and the compression on joint due to bony friction will be present and needs to perform exercises under a guided physiotherapist so the muscle stays active and strengthened. This will help avoid pain. If she has any cardiac profile and has already into menopause then the swelling will be common due to lack of venous return and hormonal changes. Getting involved in the Physical exercises is recommended in patients with chikungunya. Recent research studies show there are optimum improvements in patients with chikungunya by having regular physical exercises. Monitoring the blood pressure, blood glucose, vitamin D and calcium levels are of utmost importance under a physician. Hope I have answered your query. Let me know if I can assist you further. Take care Regards, Jay Indravadan Patel, Physical Therapist or Physiotherapist </s>