Q. Why do I get joint pain, rashes, dry mouth and eyes, bruises along with fever?

Answered by
Dr. Naval Mendiratta
and medically reviewed by iCliniq medical review team.
Published on Dec 08, 2016 and last reviewed on: Oct 09, 2018

Hi doctor,

I have had a fever for over a year now. I have joint pain in wrists and awaiting ultrasound guided steroid injections. I have three deformed fingers, premature ventricular contractions, shortness of breath, chest pain, upper back pain, neck stiffness, cracking and pain. I have dry mouth, nose, throat, eyes and now choking regularly. I had surgery for a prolapsed spinal disc and loss of sensation or power to the entire right leg.  Now, I have a rash on my face and neck and unexplained bruises and rashes. My joints crack and creak. My wrist and knuckles swell and turn red. I have ulcers in my mouth and lost weight. My BP keeps fluctuating between 69/49 mmHg and 220/202 mmHg and pulse too remains irregular between 39 bpm and 115 bpm. I also feel fatigue, irritability, aggressive with low vitamin B12. The rheumatologist, who I am visiting once in six months, is not keen to diagnose me. Please help me.

Dr. Naval Mendiratta

Rheumatology
#

Hi doctor,

Welcome to icliniq.com.

  • Well, it does look like you are having an autoimmune problem. But, the type of rash, puffy fingers, rash over the knuckles and fever does warrant us that we should evaluate you further.
  • Secondly the dry eyes, dry mouth and choking. That is a bit of concern as we need to see you do not have any other muscle weakness along with it goes on.
  • Choking can happen due to dryness also or due to the involvement of the muscles. I am not sure if you are experiencing difficulty in climbing stairs or combing your hair. And, if there is history of hair fall or oral ulcers.
  • But, I am going to advise you a few tests which you need to get done. From that we will know that exact diagnosis and can start treatment before waiting any further. In case you have done these tests, then you can update me the results.

Investigations to be done:

1. ANA (antinuclear antibodies).
2. ENA profile (extractable nuclear antigen antibodies).
3. Complete blood count.
4. ESR (erythrocyte sedimentation rate).
5. Urine routine.
6. Liver function tests.
7. CPK (creatine phosphokinase) and LDH (lactate dehydrogenase).

Differential diagnosis:

1. Lupus (inflammatory disease in which immune system attacks own tissues).
2, Dermatomyositis (skin rash, muscle inflammation and weakness).

Treatment plan:

Avoid sun exposure for the time being.

Regarding follow up:

Revert back with the reports to a rheumatologist online.---> https://www.icliniq.com/ask-a-doctor-online/rheumatologist

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