Severe pain in arms and legs

[sofa weight]

7 years ago I was diagnosed with RA. This was because I went to the doctor with pain in my knees and elbows and large bumps on my elbows. The doctor ran a rheumatoid factor test and it was positive. The doctor sent me to a rheumatologist that I saw for 5 years. I started on plaquinil, but it wasn't helpful, so switched to methotrexate. MTX made nodules go away. During the time I was getting treated wih methorexate, I had almost constant herpes outbreaks and low grade fevers. Joints got better but pain continued to get worse. He didn't find a cause for it and didn't address the pain. I changed rheumatologists. the next rheumatologist said the RA seemed to be in remission and that I probably just had fibromyalgia. I went off of the MTX and started lyrica. Lyrica made me stupid and it interfered with my job. Because of this, I saw a pain specialist who reduced the lyrica and replaced it with duragesic. Then, a couple of weeks ago, I got sick and hada fever and couldn't stand to be in a room with light. the next day pain set it. It was and is very severe. Fever is gone now, but hte pain remains. My joints are swollen again a little. I am on low dose prednisone and hasve been since october. That started because I was unable to walk. I also got a steroid shot in my shoulder on friday for inflammation. Note: only in the beginning was the rheumatoid factor positive. after that, all tests were normal. sed rate around 7, ana normal, anti-cpp normal. starting about 9 months ago, i started getting parasthesias: wet feet, burning spots. Also i got double vision. MRIS were run when I got the symptom of my leg buzzing when I moved my head. Lyme test negative. No RA tests have been run since july. Even on fentanyl and MSIR, the pain is arely tolerable. without the MSIR, I am a basket case. Any idea what is going on?

[Kevin Pho, MD]

This is a difficult case as you have been seeing several consultants already and have been evaluated by more than one rheumatologist.  It is unlikely that I can offer anything new over the internet.

The duragesic patch is a potent narcotic.  Discussing with your pain management specialist your concerns about side effects, such as sedation and mental status changes, can be considered.  

I agree with metrotrexate and Plaquenil that have been tried.  Other medications that can be tried include leflunomide, etanercept, adalimumab, infliximab, rituximab, abatacept, or anakinra.  These options should be discussed with your rheumatologist.  

As for the paresthesias - I agree with seeing the neurologist.  Nerve conduction studies, as well as blood tests for diabetes, thyroid disorders and B-12 levels should all be considered.

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_

[sofa weight]

All MRIS normal except for 1mm syrinx in thoracic spine (probably means nothing). no RA tests run for 9 months. I have visible swelling in my fingers and knees. MRI showed swelling in shoulder. Got steroid shot for that. Also, I am 36 yr old female. I am, by disposition, a very active, in shape person. In pain though, I am stuck on my sofa under a lot of blankets. Have had recurrent muscle spasms in my left arm for about a month and have lost 30 pounds in the past 6 weeks. i have no appetite and everything tastes wrong. The pain used to be like a tootheache all down my arms and legs. Left arm was ok though. The past 2 weeks, the pain has been more like an ice cream headache down my arms and legs and fingers feel like I have boils on the joints. I can handle toothache lke pain all over, but Ice cream headache like pain all over is intolerable. The pain has gotten so bad recently that I have just wanted to be knocked out. Also, I have narcolepsy, but for the past 2 weeks, the pain has been so bad that I cannot sleep. Once I do fall asleep, I wake up after a couple of hours from pain.

[deedle28]

A related discussion, will a steroid shot cause numbness? was started.