joint pain and high white count

[scdena]

My joint pain started in my hands about 5 years ago.  The pain was in the knuckles of my hands, not my fingers.   At that time my GP did tests for lupus, RA, etc. All were normal including RA factor and lupus test. Last year the joints on the tops of my feet began swelling and hurting.  There are still hard lumps there. My GP referred me to a Rheumatologist.  In the meantime my knees also started to bother me, left one being the worse. Since that time my feet, hands, hips, neck and back hurt off and on but my left knee has not stopped hurting.  I have had fluid drained off 6 times.  Test for crystals were negative. Five days ago I had to have fluid drained off (24 cc) to ease the pain.   I had a bone scan which showed "hot spots" on both knees and on the tops of both feet.  Just three days later I went to the emergency room in extreme pain in that left knee.  They drew 40 cc out.  Tests of the fluid showed: color-yellow, appear-cloudy, WBC-31,400.0 mm3, RBC-40,000.0 mm3, neutro-88.0%, lymphs-12.0%, gram stain-many WBCS no organisms.  My Rheumatologist tells me I have some kind of inflammatory arthritis but not sure what kind.  I started Prednisone about a month ago and Methotrexate last week.  As to my high white count---I have had CBC w/ diffs 9 times since Dec 2002.  Every time my WBC was high. Highest was at emergency room (17.9) Polys and neutros (same thing?) also high each time, highest at emergency room (12.4) Blood smear was done: "RBCS normal, PLTS normal, WBCS reactive changes noted, none prominently in neutrophils. Immaturity not seen." Negative blood culture. I have had 2 C Reactive Protein tests since Dec. 02 and both were high.  But I have also had 2 SED rate tests and both were normal. During all of this time I have taken 7 courses of antibiotic (Tequin, Cephalexin, Augmentin twice, doxycycline, cipro IV after septum surgery, and clindamycin which I was taking at the time I went to the emergency room.) My questions are: Have we missed something with my knee to tell us if it is RA or some other kind of arthritis? Are my CBC results connected to my knee problem or should I be looking elsewhere? Perhaps I should tell you also that I am a 49 yr. old female and have been diagnosed with: plantar-fasciitis,sleep apnea, Restless Legs Syndrome, Carpal Tunnel Syndrome, Degenerative Disk Disease, Tarlov cysts (7)resulting in chronic cauda equina syndrome (I have a lumbar-peritoneal shunt which has stopped working and the catheter is disintergrating with pieces seen on x-ray in my pelvis--source of infection?). As you can see I already have a lot of problems so if I can just find out what this joint problem is and get on a proper treatment maybe I will have one less thing to worry about. I apologize for the length but do thank you for your time and any helpful information you can give me to discuss with my doctors.

[Kevin Pho, MD]

An interesting scenario.

With a WBC of over 30k, it is suggestive of an inflammatory arthritis - as has already been diagnosed.  It would seem that you have also been treated for septic arthritis - since you have been on many antibiotics.  

Regarding you blood CBC results, I would say that it is non-specific.  WBC increases with any inflammatory conditions - whether it is some form of rheumatological disease or an infection.  Taken by itself, I cannot be sure what this means.  

With the inflammation of the knee joint, here are several other considerations: infection, crystal disease (i.e. gout or pseudogout - already been considered), Lyme disease, fungal infections, seronegative spondyloarthropathies (Reiter's syndrome, psoriatic arthritis, inflammatory bowel disease), or sarcoid periarthritis.  

Each of these diseases should be discussed with your personal physicians.  

If there continues to be confusion about the diagnoses, you may want to inquire about a joint (synovial) biopsy to give a more definitive diagnosis.  

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.

Thanks,
Kevin, M.D.

[Merle65]

A related discussion, Can arthritis cause high white count was started.