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

Answered by
Dr. Anshul Varshney
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on May 22, 2020 and last reviewed on: Jun 03, 2020

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 labs come 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 someway 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.

Dr. Anshul Varshney

Critical Care Physician Diabetology General Medicine Internal Medicine Medical Gastroenterology Nephrology Pulmonology (Asthma Doctors) Rheumatology
#

Hi,

Welcome to icliniq.com.

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

I need the following details:

Since how long are you suffering from it? Do you have an increase in pain and stiffness in the morning when you get up or is it the same throughout the day? Within how many minutes to hours of getting up in the morning you start feeling lesser stiffness? Do you have pain and swelling in distal interphalangeal joints of hands?


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Thank you doctor,

I started seeing signs since I was about 10 years old but the harsh onset was at the age of 17. I have an increase in stiffness in the morning and I am not sure about the pain because of my regiments but it normally takes me about an hour to get myself going due to stiffness. I probably would have more pain if I was not on pain medicines.

To completely leave the stiffness it takes anywhere from 45 minutes to 1.5 hours depending on the weather. And the pain and swelling occur in my metacarpophalangeal joints (MCP).

Dr. Anshul Varshney

Critical Care Physician Diabetology General Medicine Internal Medicine Medical Gastroenterology Nephrology Pulmonology (Asthma Doctors) Rheumatology
#

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.


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