Member Comments are provided by individuals and reflect their personal opinions only. Under NO circumstances should you act on any advice or opinion posted in this forum. ALWAYS check with your personal physician before taking any action regarding your health! MedHelp International and our partners, sponsors and affiliates have no obligation to monitor any comments posted on this site, or the content and/or accuracy of such exchanges. MedHelp International does not endorse the views of any user.
Arthritis (Expert Forum)
Rheumatology or Neurology Problem?
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.
Rheumatology or Neurology Problem?
by MochamommyCC, Jan 04, 2005 12:00AM
How can one be sure that one is dealing with a rheumatological problem that has neurological symptoms vs. a neurological problem? Overall problems are fatigue, flu-like malaise, muscle/joint pain (elbows,knees, jaw, neck), some sensory problems and diagnosed neurogenic bladder.
My specific questions:
1. How can one be sure of whether a problem is rheumatic vs. neurologic when there are some neurologic problems?
2. If I have arthralgia (pain in joints without swelling), how can I be sure that it is truly joint pain vs. nerve pain? What is the difference and how can one tell?
3. I have tested consistently positive for ANA (usually 640), one time for anticardiolipid antibodies (IGM of 15), and frequently high SED rate. Other than that, no other markers. Does this shed any light on rheumatic vs. neurological problems being the cause, as I understand all of these markers can be seen in normal, healthy individuals.
Thank you!
My specific questions:
1. How can one be sure of whether a problem is rheumatic vs. neurologic when there are some neurologic problems?
2. If I have arthralgia (pain in joints without swelling), how can I be sure that it is truly joint pain vs. nerve pain? What is the difference and how can one tell?
3. I have tested consistently positive for ANA (usually 640), one time for anticardiolipid antibodies (IGM of 15), and frequently high SED rate. Other than that, no other markers. Does this shed any light on rheumatic vs. neurological problems being the cause, as I understand all of these markers can be seen in normal, healthy individuals.
Thank you!
Doctor's Answer
by Kevin Pho, MD, Jan 05, 2005 12:00AM
, Jan 05, 2005 12:00AM
To answer your questions:
1) There are many diseases that can overlap between rheumatologic and neurologic conditions. Things like blood tests for an ANA level, rhuematoid factor, ESR (a marker for inflammation) can suggest a rheumatologic disorder, while tests like an EMG (electromyelogram) or MRI can suggest neurologic disorders.
2) Although not 100%, the joint pain would likely be confined to the joint, whereas nerve pain would have some radiation (i.e. spread).
3) An elevated ANA level would suggest more of a rheumatological than neurological cause.
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.
Medical Weblog:
kevinmd_b
1) There are many diseases that can overlap between rheumatologic and neurologic conditions. Things like blood tests for an ANA level, rhuematoid factor, ESR (a marker for inflammation) can suggest a rheumatologic disorder, while tests like an EMG (electromyelogram) or MRI can suggest neurologic disorders.
2) Although not 100%, the joint pain would likely be confined to the joint, whereas nerve pain would have some radiation (i.e. spread).
3) An elevated ANA level would suggest more of a rheumatological than neurological cause.
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.
Medical Weblog:
kevinmd_b
1. In researching descriptions of my pain (so I can figure out how to describe it at my upcoming appointment!), the closest thing to what I am feeling is 'dysthetic pain - dull, warm, aching'. Though my pain is in my elbows, knees, jaw/neck, it does spread somewhat into the surrounding areas outside of the joints (though n ot in a straight line). I am still having a hard time figuring out if it is joint pain (since there is no swelling, redness, OR pain on movement - just constant), since it has spread some into the surrounding areas. What is the typical way nerve pain would "spread" as was indicated in the previous reply?
2. Unless I am sure it would yield something useful, I don't know if I should repeat the MRIs of brain and spine, spinal tap, and EVPs that were done in 1999 and 2001. All were negative at the time, but urodynamics tests did show a neurogenic bladder. I am concerned that maybe there might be something indicating MS now that more time has passed. Given that I have had repeated high ANAs (640), anticardiolipids (15), and positive SED rate (53 and at times higher), would this convince you to forego the expensive neuro tests and concentrate on a rheumatic concern?
Thanks for clarifying further.
Cindy123
1) There is no "defined" way that nerve pain can spread - but the typical description is that it "radiates" from the source of compression along the path of the nerve. For instance, compression of sciatic nerve in back pain can cause radiation of pain down the leg.
2) Given the elevated levels of ANA and sedimentation rate, I would agree that a rheumatologic cause should be pursued first before a neurologic cause (esp. given the normal neurologic tests).
Thanks,
Kevin, M.D.
I think what is causing my concern is that my SED isn't always high, and I stumbled across a few abstracts from professional journals citing some MS patients have high ANAs as well. The fact the ANA has been encountered with MS patients (could it go as high as 1280 in MS?), I don't always have a high SED even when flaring, and I had the neurogenic bladder evidenced by the urodynamics test are causing me to wonder if I am going down the wrong path.
I appreciate this forum and the chance to ask these questions. I don't get the opportunity to ask but one or two things during an office visit, and the doctor is quickly moving to the next patient. Thank you for your professional insight.
Cindy123
You will have to copy the URL into your browser, because I don't know how to make a hyperlink.
Good luck.
I shoveled about 2 hours Sunday and it became worse. I am in NO pain, just uncomfortable, it is a throbbing sensation, sometimes in the middle of my shoulders also.
Can anyone help me?
What were you doing just before the flu-like symptoms showed up? That would most likely be your source of exposure.
I believe there are many late appearing 'birth defects' that it can cause, too, such as the serious arthritis (an autoimmune disfunction many times) etc
http://home.gci.net/~blessing/pages/thefatigue.htm
Why I've looked into this chemical poisoning
http://home.gci.net/~blessing/pages/who.htm