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Arthritis (Expert Forum)
PAIN
Answered by
Kevin Pho, MD - Internal Medicine
Kevin Pho, MD
Boston - MA
This forum is for questions and support regarding arthritis issues such as: Arthritis, Autoimmune Disease, Bursitis, Fibromyalgia, Gout, Juvenile Rheumatoid Arthritis, Lupus, Myositis, Neuralgia, Osteoarthritis, Polymyalgia Rheumatica, Rheumatoid Arthritis, Sciatica, Tendinitis, Vasculitis.
PAIN
by myquest, Jun 24, 2006 12:00AM
I AM A 55Y/O MODERATELY OBESE W FEMALE WITH NO OTHER HEALTH PROBLEMS EXCEPT HYPOTHYROIDISM, INTERMITTENT IBS, AND VERY MILD OA OF MY KNEES. I HAVE ALWAYS BEEN VERY HEALTHY AND PHYSICALLY STRONG.
OVER THE PAST 4 YRS I HAVE DEVELOPED PROGRESSIVE MYALGIA, ARTHRALGIA AND SEVERE FATIGUE WHICH HAS REALLY ALTERED MY LIFE. EARLY ON I STARTED OUT TAKING VIOXX AND BEXTRA WHICH WERE PERSCRIBED BY MY PCP BUT THEN THEY STOPPED BEING AS EFFECTIVE WITH PAIN RELIEF. (I DON'T DO NARCOTICS) EVENTUALL,Y I THOUGHT I PROBABLY HAD REACTIVE ARTHRITIS SO I WENT TO A RHEUMATOLOGIST. AFTER ALL THE LAB WORK MY ONLY POSITIVE RESULTS WERE A SLIGHTLY ELEVATED ESR AND AN ANA OF 1:283. (OF COURSE, HCV, GOUT, RA, ETC WERE RULED OUT.)
ULTIMATELY, THE RHEUMATOLOGIST SAID HE DID NOT KNOW WHAT WAS WRONG WITH ME. HE SAID HE DOESN'T THINK I HAVE LUPUS OR IF I DO IT IS A VERY MILD CASE. (IF HE THINKS THIS IS MILD HE SHOULD LIVE IN MY BODY FOR A WEEK.) AT HIS SUGGESTION, I TRIED TAKING HYDROXYCHLOROQUINE FOR 3 MONTHS BUT THE FATIGUE BECAME ALMOST DISABLING & I NOTICED NO RELIEF OF THE PAIN. SO, I QUIT TAKING THE MEDICATION 4 MONTHS PREVIOUS.
ORIGINALLY, I FELT AS IF I WAS NOT PROVIDED ADEQUATE INFORMATION FROM THE RHEUMATOLOGIST SO NOW I DON'T KNOW WHAT TO DO NEXT. THE PAIN, FATIGUE AND WEAKNESS CONTINUE TO SEVERELY ALTER MY LIFE.
MY SX'S ARE BASICALLY THIS:
POLY ARTHRALGIA (THUMBS, KNEES, ANKLES, & SOMETIMES GREAT TOES-THE PAIN IS OF VARING INTENSITY AND MOST NOTICABLE IN THE MORNING AND AT NIGHT. MYALGIA - EVERYTHING HURTS. I USED TO HAVE A MASSAGE REGULARLY BUT NOW CAN'T TOLERATE THE PAIN. MY LAST MAMOGRAM WAS ALMOST UNBEARABLE. THE SLIGHTEST PRESSURE ON MY LATERAL THIGHS, THE MEDIAL ASPECT OF MY ELBOWS & KNEES CAUSES PAIN. MOST OF MY PAIN FEELS AS IF IT IS SOFT TISSUE PAIN. I HAVE ALSO NOTICED WHAT TO ME IS PROGRESSIVE WEAKNESS WHEN LIFTING BOXES, OPENING JARS ETC. I HAVE GOOD DAYS AND BAD DAYS. I HAVE BECOME MORE AND MORE SEDENTARY BCS OF THE PAIN AND WEAKNESS. IT IS AN EFFORT TO DO ALL THE THINGS I NEED TO DO AFTER WORK AND "FUN" THINGS AREN'T REALLY FUN ANYMORE BCS OF THE FATIGUE AND PAIN. THE PAIN IS MITIGATED SOMEWHAT BY LARGE DOSES OF NSAIDS AND TYLENOL.
I HAVE SPENT SOME VACATIONS AT MY DAUGHTERS HOME IN VA - THERE ARE DEAR IN HE BACK YARD. I HAVE LIVED IN MANY DIFFERENT STATES INCLUDING THE NORTHEAST AND SPENT TIME IN VENEZUELA & MEXICO.
I GUESS WHAT I AM LOOKING FOR TODAY IS INFORMATION. IF I DON'T HAVE LUPUS WHAT IS THE DIFFERENTIAL DX? I ALSO NEED HELP IN FINDING A REALLY GOOD RHEUMATOLOGIST.
OVER THE PAST 4 YRS I HAVE DEVELOPED PROGRESSIVE MYALGIA, ARTHRALGIA AND SEVERE FATIGUE WHICH HAS REALLY ALTERED MY LIFE. EARLY ON I STARTED OUT TAKING VIOXX AND BEXTRA WHICH WERE PERSCRIBED BY MY PCP BUT THEN THEY STOPPED BEING AS EFFECTIVE WITH PAIN RELIEF. (I DON'T DO NARCOTICS) EVENTUALL,Y I THOUGHT I PROBABLY HAD REACTIVE ARTHRITIS SO I WENT TO A RHEUMATOLOGIST. AFTER ALL THE LAB WORK MY ONLY POSITIVE RESULTS WERE A SLIGHTLY ELEVATED ESR AND AN ANA OF 1:283. (OF COURSE, HCV, GOUT, RA, ETC WERE RULED OUT.)
ULTIMATELY, THE RHEUMATOLOGIST SAID HE DID NOT KNOW WHAT WAS WRONG WITH ME. HE SAID HE DOESN'T THINK I HAVE LUPUS OR IF I DO IT IS A VERY MILD CASE. (IF HE THINKS THIS IS MILD HE SHOULD LIVE IN MY BODY FOR A WEEK.) AT HIS SUGGESTION, I TRIED TAKING HYDROXYCHLOROQUINE FOR 3 MONTHS BUT THE FATIGUE BECAME ALMOST DISABLING & I NOTICED NO RELIEF OF THE PAIN. SO, I QUIT TAKING THE MEDICATION 4 MONTHS PREVIOUS.
ORIGINALLY, I FELT AS IF I WAS NOT PROVIDED ADEQUATE INFORMATION FROM THE RHEUMATOLOGIST SO NOW I DON'T KNOW WHAT TO DO NEXT. THE PAIN, FATIGUE AND WEAKNESS CONTINUE TO SEVERELY ALTER MY LIFE.
MY SX'S ARE BASICALLY THIS:
POLY ARTHRALGIA (THUMBS, KNEES, ANKLES, & SOMETIMES GREAT TOES-THE PAIN IS OF VARING INTENSITY AND MOST NOTICABLE IN THE MORNING AND AT NIGHT. MYALGIA - EVERYTHING HURTS. I USED TO HAVE A MASSAGE REGULARLY BUT NOW CAN'T TOLERATE THE PAIN. MY LAST MAMOGRAM WAS ALMOST UNBEARABLE. THE SLIGHTEST PRESSURE ON MY LATERAL THIGHS, THE MEDIAL ASPECT OF MY ELBOWS & KNEES CAUSES PAIN. MOST OF MY PAIN FEELS AS IF IT IS SOFT TISSUE PAIN. I HAVE ALSO NOTICED WHAT TO ME IS PROGRESSIVE WEAKNESS WHEN LIFTING BOXES, OPENING JARS ETC. I HAVE GOOD DAYS AND BAD DAYS. I HAVE BECOME MORE AND MORE SEDENTARY BCS OF THE PAIN AND WEAKNESS. IT IS AN EFFORT TO DO ALL THE THINGS I NEED TO DO AFTER WORK AND "FUN" THINGS AREN'T REALLY FUN ANYMORE BCS OF THE FATIGUE AND PAIN. THE PAIN IS MITIGATED SOMEWHAT BY LARGE DOSES OF NSAIDS AND TYLENOL.
I HAVE SPENT SOME VACATIONS AT MY DAUGHTERS HOME IN VA - THERE ARE DEAR IN HE BACK YARD. I HAVE LIVED IN MANY DIFFERENT STATES INCLUDING THE NORTHEAST AND SPENT TIME IN VENEZUELA & MEXICO.
I GUESS WHAT I AM LOOKING FOR TODAY IS INFORMATION. IF I DON'T HAVE LUPUS WHAT IS THE DIFFERENTIAL DX? I ALSO NEED HELP IN FINDING A REALLY GOOD RHEUMATOLOGIST.
Doctor's Answer
by Kevin Pho, MD, Jun 26, 2006 12:00AM
, Jun 26, 2006 12:00AM
Various rheumatological diseases continues to be possible. This can include lupus or rheumatoid arthritis. Other considerations would be Lyme disease, vasculitis, or myositis.
If there is a mild case of lupus, other medications can be considered for treatment.
Repeating the ANA level, along with other markers of inflammation like CRP can be considered.
Another rheumatological opinion can be sought - preferably at a major academic medical center.
These options can be discussed with your personal physician.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
kevinmd_
If there is a mild case of lupus, other medications can be considered for treatment.
Repeating the ANA level, along with other markers of inflammation like CRP can be considered.
Another rheumatological opinion can be sought - preferably at a major academic medical center.
These options can be discussed with your personal physician.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
kevinmd_
It has a wealth of information to share ,