painful symptoms and no diagnosis

[fluffygranny]

My 35 yr. old daughter has had unprovoked flair-ups of both shoulders and her right knee on separate occasions that required trips to the ER over the last several months.  The last being her knee and was the most severe. The knee was easily three times it normal size.  She was in terrible pain.  The doctor drew 3 vials of fluid off the knee.  The tests they ran told us nothing but the fluid was the consistency of hair gel.

She is also suffering with nausea and headaches a general decline in health and ability to function.  Her doctor keeps trying her on anti inflammatory drugs but won't refer her to a specialist. She isn't required to have a referral but we find specialists won't see her without one.  In the meantime she is in a decline that frightens me.

Any suggestions would be gratefully received.

[Kevin Pho, MD]

Regarding the swollen knee, there are various causes for monarthritis.  The results of this knee fluid is important to the diagnosis.  

The three main diagnoses to consider in a patient who presents with acute monoarticular symptoms are trauma, infection, and crystalline disease (gout and pseudogout). Lyme disease and certain systemic disorders are also commonly considered when determining as cause.  

Analysis of the fluid should be able to narrow down the list of causes.  You may also want to obtain an ANA level (to evaluate for lupus) as well as a rheumatoid factor to evaluate for rheumatoid arthritis if the diagnosis is still in question.

If there continues to be question about the diagnosis, I would suggest a rheumatology referral.

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.

Bibliography:
Helfgott.  Approach to the patient with monoarticular joint pain.  UptoDate, 2004.