What tests do I need?

[j.mariec]

I am a female. Age 53.  I can NOT stand or walk for longer than 15-30 minutes.  It causes tight burning pain throughout leg muscles, which gets worse (unbearable), until I have to sit down.  My leg muscles will get stiff & heavy (like lead), and it's hard to lift them.  It gives me an unsteady lumbering gait.  (Sometimes, I have loss of balance.)  The leg pain stops when I sit down.  The heaviness/stiffness will subside slowly, after a long time, but it never completely goes away.  I also have loss of function in my knees.  They are stiff & sore.  Standing/walking makes them get "stiffer & weaker," and it's hard to climb steps, or get off the bus. My knees have no strength.  I can NOT step onto a 12" stool.  And my knees don't bend right. I walk sideways down steps.

Lately, I have heaviness/soreness/weakness in upper back and arms. It is hard to get dressed.  When I wake up, my eyes are dry.  I also feel sick & tired every day, heartburn and a cough.  

In 2004, I had normal tests for: CBC, MET, TSH, RF, SED and doppler of legs.  An ECG had a borderline R wave.   A urine test had a trace of blood/bacteria, and haline casts.  X-rays of lumbar spine showed DDD.  My upper back was NOT imaged.)  My doctor prescribed hydrochlorothiazide 50mg (for HBP 150/90.), and Flexeril 10mg (for my legs.)  I was also on prednisone 10mg for two weeks.  I vomited.)  The doctor was not sure of a diagnosis.  And I was sent to other doctors:

2005-A rheumatologist.  (He took "NO" additional tests, and did not examine me).  He felt the creaking in my knees, with his hands, and the nurse examined my enlarged knuckles.  He said I had fibromyalgia, OA of both hands and both knees.  His nurse told me to "only tell him three symptoms at a time."  But, I told him everything!
2006-An internist.  He said: "sica syndrome...vertigo...and something else could be going on."  An MRI of neck showed mild stenosis/and an MRI of lumbar spine showed facet disease.  He prescribed Nexium 20mg (for reflux/cough), and told me to use a saline solution in my eyes.  Legs still hurt!

When symptoms started:
1999-Fingers hurt/turn red in cold.
2000-Numbness & small ulcer on "third left toe".
2001-Knees stiff & sore. I can't get up if I sat on the floor!
2002-Morning muscle and joint stiffness: (Legs, knees, ankles.)
2003-Outer ankle bones: stiff/sore/tissue swelling. I gain/loose 5 lbs a day. Urine is cloudy at night.
2004-Upper back: stiff/rigid/limited movement. Back of neck: stiff.
2005-Morning: headaches/nausea/exhaustion.   By afternoon I am "wiped out".  Momentary pulses in head with vision darkening. Also: The hair has stopped growing on both legs.  Itchy rashes on chest.
2006-Morning numbness in fingers. Upper arm muscles & fingers weak. Chest heaviness: hard to breathe when walking/bending over.
Since March 2006: Both end joints on little fingers: stiff/sore/numb.
Since June 2006: Finger tips red-fades if I raise arms up.

What is wrong? What tests do I need?

[crystaly]

Hi Just thought I'd let you know that I have more or lss the same symptoms as you apart from I also have myoclonus (jerky walking ) I have had my symptoms for 2 yrs and have seen a neurologist . My dx is an undiagosed neurological disorder plus a gait (movement disorder origins not known. I agree you should see a neurologist . Incidently my mum had RA for years before dx as well. Good Luck Chris

[j.mariec]

Thank you.  I forgot to mention that I have stiffness/weakness in my low spine (between my hips), that is worse in the mornings, and gets better if I bend forward.  This started five years before my leg symptoms started, and has been getting worse each year.  Also, I was tested for ANA two years ago, and it was 1:40.  The doctor did not do any other followups.  My mother had RA, undiagnosed for many years.  Could I have that, and need other tests for it?  Thank you for your help.

[Kevin Pho, MD]

I would consider a neurology referral at this point - given the symptoms of weakness and numbness.  Your MRI did not show revealing central CNS disease.  You can consider EMG studies to evaluate for any nerve conduction disorders.  

Blood tests also looking for rheumatological disease - such as an ANA test - or tests specific to muscle inflammation (myositis) can also be considered.

A more specialized test, like a muscle biopsy, can also be considered if the initial tests are non-revealing.  

As mentioned previously, a neurology referral should be pursued.  A second rheumatological opinion can also 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_