PAIN

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 (mammogram) 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.

[Kevin Pho, MD]

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_

[myquest]

SORRY, I FORGOT TO ASK IS WHAT ADDITIONAL STUDIES/LAB WOULD BE INDICATED.

[bbird]

I have all of your symptoms and was dx. with Fibro approx 6 years ago.  I had many, many different kinds of tests and all the results were normal.   I saw many different kinds of doctors.   All gave me the same dx.   I don't really know what is wrong with me but my life is basically trying to make it from one day to the next.   It is a very hard life.    What makes it even worse, is that I don't really know what is wrong with me.   Does Fibro really exist?   Or is it just something they tell us we have to get rid of us?   Very frustrating !

[Belledonna]

My good friend from high school is now CEO of the Mary Kirkland fReserch Foundation for Lupus--look up their web site--DXLUPUS.org
It has a wealth of information to share ,

[Kalio1]

Lots of people who are diagnosed with fibro are found to have hepatitis c virus. I'd be checked for hep b and c as they can be very sneaky and show no obvious syptoms (symptoms) for many years and are often misdiagnosed as fibro. They can cause these types of symptoms. They are infectious diseases and many people have it and have no idea they have it while it eats away at their liver. Please be tested to rule it out. It is called a "silent killer" disease for a reason.

[maybelene]

A related discussion, poly arthralgia was started.