I have pain in joints with bad flares in hands, knees, and hips. Please suggest possible diagnosis.

Question

Hello doctor,

I have been to six different rheumatologists. One of those rheumatologists said I have fibromyalgia and I still do not agree with this diagnosis. My reports came back normal. My radiographic test concludes osteoarthritis in both knees and thumbs. I have pain in these joints and have a bone island in my right knee. I am under pain management, but I just feel like we are missing something. My body feels way off and I am almost positive with seronegative RA. I just feel like the physicians are in some way scared to conclude this diagnosis. I have bad flares that are bilateral on my hands, knees, hips, and between my shoulder blades. I have swelling and fever in these joints. I have no idea what to do but I am progressively getting worse. Please help. I am currently taking Nucynta ER 150 mg, Xanax 1 mg, Lyrica 100 mg, HS Tizanidine 2 mg, and Synthroid 25 mcg before meals.

Please help.

Answer 1

Hi,

Welcome to icliniq.com.

I went through your query.

You seem to have multiple joint arthritis. Since CRP (C-reactive protein), R factor, Anti CCP (cyclic-citrullinated antibody) antibody, and ESR (erythrocyte sedimentation rate) are normal, no one is going to conclude this as rheumatoid arthritis or seronegative arthritis. I need the following details:

1. Since how long are you suffering from it?

2. Do you have an increase in pain and stiffness in the morning when you get up or is it the same throughout the day?

3. Within how many minutes to hours of getting up in the morning do you start feeling lesser stiffness?

4. Do you have pain and swelling in the distal interphalangeal joints of the hands?

Kindly update with the answers.

Thanks and regards.

Answer 2

Hi,

Welcome back to icliniq.com.

Yes, actually your symptoms do fit into rheumatoid arthritis. So in such cases, my opinion is to give a cortisone shot and give medicines like Hydroxychloroquine HCQS for a few weeks. Also, take good calcium supplements with vitamin D. Based on the response we can decide further treatment. This is a very doubtful diagnosis as no investigations are positive, not even basics like ESR (erythrocyte sedimentation rate) and CRP (C-reactive protein). If there is no relief with the mentioned treatment then we revise the diagnosis to osteoarthritis or osteoporosis. You need to share my opinion with your treating doctor and if the doctor agrees he would also prescribe you these medicines as these are prescription medicines.

I hope this helps.

Thanks and regards.

Answer 3

Hello,

Welcome back to icliniq.com.

Any Rheumatological diseases are best evaluated on clinical examination. So, if your doctor feels ,that this is osteoarthritis with fibromyalgia, he must be right as he has examined you. I suggest you take medicines with his consent. I hope it helps you. If you have any further query, please ask me.

Thanks and regards.