sore throat and joint pain connection

I have a 9year old daughter. And she has a medial history since she was 2months old. She was born as a healthy child and on 2months she was to be hospitalized for severe stomach infection and dehydration. After that she became lactose and sucrose intolerant and had severe diarrhea and gastroenteritis infections every 10 days and that would last for a week. All this settled down when she turned 15months old. She started digesting normal food. Then one fine day when she was nearly 20 months old I took her to a family get-together and she started complaining of pain in her knee. I  thought she is tired after a long hectic day and would be fine after some rest. But to my surprise the pain grew stronger and unbearable for the child. She also started puking due to fear and wouldn't let anyone come near her or move her leg at all. She would just sit at one place. I showed her to doctor and he prescribed beardy. This settled down after 48hrs. Then it reoccurred after a month and this became a regular feature after every month or couple months. The other joints like shoulder, hands, wrists, hip etc started getting affected. I consulted various doctors and tried allopath, homeopathy and ayurvedic treatments for couple years and then finally settled down with a child rheumatologist who treated her with prednisone and methotroxate for 3 years. She showed considerable improvement and her life style became very close to normal kids but of course she is not very athletic. Then we moved to States where we showed her in Children's hospital, Cincinnati and after doing all tests they concluded that she is a case of hyper mobility and not rheumatoid arthritis. She is off methotroxate for one and a half years now and is doing well except for a very few episodes (once in (4months) of pain in her knee or hip joint. She becomes fine with-in 24 to 48hrs with some NSAIDS and hot pack treatment. She has come a long way. I personally feel she is 80-90% better.
What really bugs me is I am not able to decide what her problem is and how should we get out of it completely. As a home-mother I am seeing her since birth and my experience tells me that whenever she has a throat infection the pain comes along for sure. The pain is independent of throat but she gets more prone with throat infection and excessive outdoor play (2-3hrs). I have discussed this with her doctors several times but haven't got any satisfactory reply. What should be my next step in bringing her out of this situation? Hw should I build her strength so she can play outdoor games for longer hrs. Please advice.

[Dr. Kokil Mathur]

Hi

Thanks for writing. I can understand your concern.

A general good health should be aimed at through a carefully planned diet rich in fruits, vegetables, egg, proteins etc. Milk, milk products and carbohydrates will have to reduced to the minimum if she still has the intolerance. Does she have Celiac disease or irritable bowel? A careful tolerance to exercise should be built under the guidance of a physiotherapist or sports teacher to develop her stamina. Prolonged illness in a child can reduce her stamina and diet.

Hypermobility syndrome, which results in ligamentous strains and a tendency for joint dislocation, can be detected by checking for hyperextension of the elbows and knees and excessive mobility of the thumb. Is this true for your daughter?
“Hypermobility may also be symptomatic of a serious medical condition, such as Ehlers-Danlos syndrome, Marfan syndrome, rheumatoid arthritis, osteogenesis imperfecta, lupus, polio, downs syndrome, morquio syndrome, cleidocranial dysostosis or myotonia congenita.” In this problem repeated gastric symptoms and throat symptoms due to reflux of gastric contents is expected.
Please refer: http://en.wikipedia.org/wiki/Hypermobility

Your daughter’s joint pain could also be due to reactive arthritis. In her case it could be due to throat infections. A throat swab can detect the organism. Please refer: http://en.wikipedia.org/wiki/Reactive_arthritis#Signs_and_symptoms


It is difficult to comment beyond this without examining her and a more detailed discussion. Please let me know if there is any thing else and do keep me posted. Take care!