Rheumatology or Neurology Problem?

[MochamommyCC]

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!

[Kevin Pho, MD]

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

[MochamommyCC]

I will probably post this as a separate question, but did want to follow-up on the doctor's response to see if anyone else had comments as well!

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

[kevinmd]

To answer your follow-up questions:
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.

[MochamommyCC]

Is it still probable that my problems lie in the rheumatic arena given that the SED rate isn't *always* abnormal when I'm having a flare up? My last bloodwork showed ANA of 1280 (speckled and homogenous), but with a SED of 12. This is when I felt awful and would have expected a higher SED rate given my level of pain at the time.

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

[MLWTR]

Sed rate (ESR) doesn't always correlate very well with disease severity. The following abstract available on MEDLINE might interest you: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=1364874

You will have to copy the URL into your browser, because I don't know how to make a hyperlink.

Good luck.

[donnarini]

first of all I am always severely stressed.  Lately I have been feeling numbness, tingling, on my right shoulder (lower).  it is driving me crazy.  

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?

[Mother Margaret]

Based on the assortment of symptoms you share, I would strongly suggest that you consider exposure to ethylene glycol monobutyl ether (2-butoxyethanol)  It causes all of these by itself.  I suspect that it is the cause of CFS, CFIDS, FM ... the 'gulf war syndrome' symptoms and what happened to many during WWII and the Vietnam War.

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

[arries]

Hi I was just reading these comments, some bring a question for me. I've been having pains in my ankles and fee for years.  This pain seems to have progressed to other areas such as knees most joins in my left side.  Both wrist areas with some feeling of pain "radiating" while picking things up like say a pot of beans or even cutting a pizza in my right hand with a knife.  I've had in the past 1992 ANA 640 at one lab then again at another lab in 2004 ANA 320 both ANA are the Nucleolar Pattern.  My ESR was 23 [considered high from this lab] my RF was less than 20 with the lab range 0-20.  I also get itching all over sometimes with not rashes, but lately I've had again some itching in my knuckles again with little bumps.  I'm currently using a steroid cream, on these, but my VA people always look at me funny.  I've had a Rheumatology appointment, but the attending over the students didn't seem to care, and he said that everyone has a high ANA, then he asked the intern what my ANA was, but the intern didn't know it at the time, I left the appointment not better than going to it.  Since I was in the military, though not in any "war" areas, I was exposed to chemical both acute and chronic long term without realizing it, and I've been trying question this exposure to these problems.  I did have an MRI, and that was normal, the neurology doctor said that I have clonus in my left foot.  I never knew what the was, but I get that in other parts of my body too at times, but nothing while in the visit except my left foot.  Sometimes both legs bounce while on the toilet or if I'm holding a bowl of soup in my left my left hand shakes, but other things may or may not make anything shake.  

So, what are your opinions?
Would this be considered Neurological or Rheumatologic?

[Mother Margaret]

Do you have other health ailments?  If so, do you remember a time when your eyes burned & hurt and your urine turned dark and a FATIGUE hit ... after 'flu-like' symptoms?

2-butoxyethanol affects so many parts of the body: joints, cartilage, blood, immune system, nervous system, could be any of the*glands/organs, kidneys, liver ... a lot of things.  However, if you don't have more than one thing wrong, don't suspect this chemical.

Other things that would most likely show up with it, would be this for fatigue:

Chills
Fatigue
Pale color
Shortness of breath
Rapid heart rate 
Yellow skin color (jaundice)
Dark urine
Enlarged spleen
Eyes burning & hurting (with initial exposure - flu symptoms, too)
Red blood cells immature
Blood in Urine (part of autoimmune hemolytic anemia)

In addition there are many times, off and on, Horrible Headaches!

The Central Nervous System damage gets the most attention, things like:
Difficulty Concentrating
Short Term Memory Loss
Difficulty Sleeping
Constantly Irritable
Depression
Suicidal Tendencies

Look at this list, and tell me if you (or one of your parents) had these symptoms.  (It is a teratogen that has been out there since 1930's so singlular items can show up as birth defects)

I strongly suspect it for causing most of the autoimmune health ailments of which joints can be one.  BUT the USA doesn't realize this. http://home.gci.net/~blessing/pages/drUssery.htm

[arries]

I know that I was exposed to a pesticide dichloropropene, which is currently banned or regulated use.  Back then I think it was regulated.  I've been trying to prove that my problems were cause by exposure.  Though I never served in the Gulf War I seem to have similar symptoms such as strange rashes, severe headaches, of course depression, but that was never noted.  I do recall strange moody behavior, now that I've red some of your stuff. I never knee what was wrong or why this was happening. None of that is in my record though because that's something a soldier wouldn't normally want in their records if they wanted to continue a career, so I'd never complain much.  Howe ever, the other medical stuff is recorded; they never knew what it was.  I also had very high blood pressure, but not treated.  All this seemed to have started in 1987, though some things like rashes only occasionally.  In 1988, for some reason I also would get severe right abdominal pains.  Thanks for your information.

[Mother Margaret]

Well you are welcome.

Some think that the chemical I've been sharing about is in jet fuel.  So that is why you don't have to be in the gulf war to come down with the 'gulf war syndrome'  I suspect it is the primary harm to the Vietnam vet - more than dioxin

http://home.gci.net/~blessing/pages/vietnam.htm

Some questions I gave some thought to on another forum:
http://www.valdezlink.com/pages/qonkidneyharm.htm

This person had concerns, they thought for kidney harm because the doctor didn't know why the blood in urine, etc.   But maybe not.

The pains you describe from this chemical's harm (& maybe some other types of pesticides, too) are an autoimmune thing going on.  I would be particularly concerned about small bumps.  Can you get one of them biopsied?  Better sooner than later, I always say.