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Neurology (Expert Forum)
Joint pain, swelling, fatigue.
Answered by
CCFNeuroMD JT, MD - Neurology/Epilepsy, Neurology/General
Cleveland - OH
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Joint pain, swelling, fatigue.
by RipleyLove, Feb 19, 2008 08:37AM
I am seventeen years old.
Over the past several months (probably since late October or early November,) I've been having severe joint pain and swelling, accompanied by chronic fatigue, headaches, limited range in movement, and occasional fever and/or nausea. I also have a very hard time sleeping, and have experienced what feel like heart palpitations, or racing of the heart at completely sporadic times. I've been to the doctor four times for this, and two rounds of bloodwork have been done. The first round came back negative for Lyme, Lupus, Thyroid disease, Arthritis, Fibromyalgia and other similar disorders. I am awaiting the results of the second round of bloodwork, but even as I type, I am in extreme discomfort, and am very tired, after even 9 hours of sleep on a regular sleeping schedule.
About a week before this began, I came down with a bad virus that included vomiting, a high fever, and a strange rash all over my body. It lasted only a few days, and the rash subsided around the time that my symptoms started. Doctors initially thought that this onset of symptoms was caused by this virus, but it is February now, and they say it has gone on too long to be viral. I have an appointment with a Rheumatologist on Thursday the 22nd of February, and I hope he will be able to enlighten me as to what it is I have. This constant discomfort is getting old...I feel like a 70 year old woman, and I'm only 17.
Does anyone have any ideas on what this might be? Does bloodwork for diseases like Lupus and Lyme often come back negative when in fact a person has the disease? I would really appreciate some input, as the doctors seem to have no idea what's going on.
Over the past several months (probably since late October or early November,) I've been having severe joint pain and swelling, accompanied by chronic fatigue, headaches, limited range in movement, and occasional fever and/or nausea. I also have a very hard time sleeping, and have experienced what feel like heart palpitations, or racing of the heart at completely sporadic times. I've been to the doctor four times for this, and two rounds of bloodwork have been done. The first round came back negative for Lyme, Lupus, Thyroid disease, Arthritis, Fibromyalgia and other similar disorders. I am awaiting the results of the second round of bloodwork, but even as I type, I am in extreme discomfort, and am very tired, after even 9 hours of sleep on a regular sleeping schedule.
About a week before this began, I came down with a bad virus that included vomiting, a high fever, and a strange rash all over my body. It lasted only a few days, and the rash subsided around the time that my symptoms started. Doctors initially thought that this onset of symptoms was caused by this virus, but it is February now, and they say it has gone on too long to be viral. I have an appointment with a Rheumatologist on Thursday the 22nd of February, and I hope he will be able to enlighten me as to what it is I have. This constant discomfort is getting old...I feel like a 70 year old woman, and I'm only 17.
Does anyone have any ideas on what this might be? Does bloodwork for diseases like Lupus and Lyme often come back negative when in fact a person has the disease? I would really appreciate some input, as the doctors seem to have no idea what's going on.
Doctor's Answer
by CCFNeuroMD JT, MD, Mar 12, 2008 12:47PM
, Mar 12, 2008 12:47PM
To: RipleyLove
Dear Ripley Love,
Thank you very much for your question. I am happy to address the issues that you pose, although it is important that you recognize that my impression is based entirely on the information you have provided in your posting and is by no means a replacement for an office visit with a neurologist. Diagnosis is contingent on detailed history and physical exam and as such, the following information should be considered solely for educational purposes.
Let me preface my answer by stating that your symptoms are rather non-specific and without having an opportunity to review your medical history, neuroimaging, and blood work that his been done, it is difficult for me to provide you with any definitive answers. it sounds like you have had a fairly comprehensive workup, including evaluation for rheumatological problems. Indeed, various rheumatic diseases may oresent with symptoms such as the ones described, so if you haven't already an appointment with a rheumatologist may be of some help.
Before I start sending you to other subspecialists, there is one particular neurologic diagnosis that comes to mind for which you may consider seeing a neurologist who can better assess you in the office setting. You give me a history of what sounds to be like some sort of viral illness about one week prior to symptom onset. With this history, some sort of a chronic festering meningitis is certainly a possibility. Patients on medications that suppress the immune system such as prednisone, methotrexate, imuran, etc. are more prone to this type of meningitis. This sort of meningitis is generally viral in etiology and is not the "big bad" meningitis that is caused by bacteria. DIagnosis is fairly simple: a lumbar puncture (i.e. spinal tap) will demonstrate elevated white blood cells.
Now, the chronic meningitis does NOT explain your joint swelling and if all of your symptoms reflect a common diagnosis, I think that this is likely an autoimmune process, which often occur following a viral illness. Basically, the body develops antibodies which "attack" parts of the body resulting in symptoms such as the ones you describe. Although I cannot tell you exactly which autoimmune condition you are experiencing, your story makes it sound like this is the most likely possibility. In some cases, rheumatologists will often treat empirically without a definitive diagnosis for an autoimmune processs if the clinical suspicion is high and there is no evidence of infection (hence, a lumbar puncture may be needed).
Finally, a third, less likely diagnosis would be a paraneoplastic process (rare). In some cancerous conditions, there are antibodies that are formed (similar to in autoimmune disease) which can attack various parts of the body. Sometimes, a paraneoplastic process precedes any physical evidence of cancer for years. There are certain blood screens and spinal fluid screens that can be sent to look for evidence of a paraneoplastic syndrome. Hence, a thorough screen for malignancy is warrented.
So, the above is a fairly comprehensive differential diagnosis. Again, I think that autoimmune disease is most likely but alternative processes such as a chronic meningitis or a paraneoplastic syndrome are also possible. I hope this information has been helpful to you. Thank you for your question.
Sincerely,
JBT, MD
Thank you very much for your question. I am happy to address the issues that you pose, although it is important that you recognize that my impression is based entirely on the information you have provided in your posting and is by no means a replacement for an office visit with a neurologist. Diagnosis is contingent on detailed history and physical exam and as such, the following information should be considered solely for educational purposes.
Let me preface my answer by stating that your symptoms are rather non-specific and without having an opportunity to review your medical history, neuroimaging, and blood work that his been done, it is difficult for me to provide you with any definitive answers. it sounds like you have had a fairly comprehensive workup, including evaluation for rheumatological problems. Indeed, various rheumatic diseases may oresent with symptoms such as the ones described, so if you haven't already an appointment with a rheumatologist may be of some help.
Before I start sending you to other subspecialists, there is one particular neurologic diagnosis that comes to mind for which you may consider seeing a neurologist who can better assess you in the office setting. You give me a history of what sounds to be like some sort of viral illness about one week prior to symptom onset. With this history, some sort of a chronic festering meningitis is certainly a possibility. Patients on medications that suppress the immune system such as prednisone, methotrexate, imuran, etc. are more prone to this type of meningitis. This sort of meningitis is generally viral in etiology and is not the "big bad" meningitis that is caused by bacteria. DIagnosis is fairly simple: a lumbar puncture (i.e. spinal tap) will demonstrate elevated white blood cells.
Now, the chronic meningitis does NOT explain your joint swelling and if all of your symptoms reflect a common diagnosis, I think that this is likely an autoimmune process, which often occur following a viral illness. Basically, the body develops antibodies which "attack" parts of the body resulting in symptoms such as the ones you describe. Although I cannot tell you exactly which autoimmune condition you are experiencing, your story makes it sound like this is the most likely possibility. In some cases, rheumatologists will often treat empirically without a definitive diagnosis for an autoimmune processs if the clinical suspicion is high and there is no evidence of infection (hence, a lumbar puncture may be needed).
Finally, a third, less likely diagnosis would be a paraneoplastic process (rare). In some cancerous conditions, there are antibodies that are formed (similar to in autoimmune disease) which can attack various parts of the body. Sometimes, a paraneoplastic process precedes any physical evidence of cancer for years. There are certain blood screens and spinal fluid screens that can be sent to look for evidence of a paraneoplastic syndrome. Hence, a thorough screen for malignancy is warrented.
So, the above is a fairly comprehensive differential diagnosis. Again, I think that autoimmune disease is most likely but alternative processes such as a chronic meningitis or a paraneoplastic syndrome are also possible. I hope this information has been helpful to you. Thank you for your question.
Sincerely,
JBT, MD
Thanks
Janine
if your never exposed to chicken pox or already had chicken pox as a kid, thats an indicator.
adult immune systems react very different to the virus than children. if you have Fifths disease, it presents with rhumatic joint pain and swelling,cardio symptoms,flulike feelings and fatique as the main presentation..
some of these individuals get chicken pox like lesions on their skin or red rashes,some do not.people in or near schools or children in general can get this as kids can be a ''carrier'' after they have had pox,or before they exhibit symptoms.its an infection,and may need medicine to go away.
my mother developed simular conditions when i had chicken pox. and thats what it was. ironicly my dad didnt get it.*????*