Dr. Nupoor Acharya
Rheumatology
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Patient's Query
Hello doctor,
I am a 25-year-old male. I have been seeing a rheumatologist with no diagnosis, but I have joint pain, blurry vision, and fatigue that are getting worse. It feels like my body is shutting down. In terms of tests, the only abnormal test I have are positive ANA but no specific antibodies that came back positive. I also have a rare myelocyte on CBC and a slightly elevated MCHC. LDH is also slightly elevated. Other symptoms include upper abdominal pain, constant phlegm in my throat, and shortness of breath. My heart rate is usually around 100 even at rest, and blood pressure is generally elevated 140s-150s over 100. O2 saturation is 95 to 99%. The main symptom is joint pain, which has made activities that I used to enjoy impossible, like weight lifting and playing basketball. I feel like my body is weakening and would like to get help.
Hello,
Welcome to icliniq.com.
Your symptoms are non-specific and do not fit into a single diagnosis of arthritis. You have not mentioned your joint pains in detail. It will help me understand the pattern of arthritis. Which joints are involved? Do you have swelling, morning stiffness, backache, joint deformity? Your ESR (erythrocyte sedimentation rate) is normal, which goes against inflammatory disease. ANA (antinuclear antibody) is positive, though the pattern is non-specific. To confirm the antibodies, you should get an ENA (extractable nuclear antigen) profile. Other tests that might help are muscle enzymes, CRP (C-reactive protein), C3, C4. The rest of your symptoms, like heart rate and breathing, seems more likely due to anxiety. How is your sleep? If you are having difficulty sleeping and low mood, your symptoms could be related to fibromyalgia. Also mention, if you are taking any medicines? Meanwhile, you can start with tablet Naproxen 500 mg twice a day and tablet Pregabalin 75 mg at night. Get the tests mentioned above.
I hope this helps.
Patient's Query
Hello doctor,
CRP has been done and was normal. Sleeping is an issue for me since I was five years old. Fibromyalgia would be hard for me to digest. I do not see it as a real disease. I believe this is a disease of elimination. When the doctors cannot find the actual disease, the fibromyalgia diagnosis is made. The knee pain is the worst joint and hip pain when sitting. I wake up most days with morning stiffness, but knee pain is the worst when walking upstairs and is located around the knee cap. There is no swelling and no signs of inflammation other than the myelocyte. I do not believe I have bad C3 or C4 done yet. I am only taking Amitriptyline 10 mg QHS. No joint deformity or backache. The joint pain makes it difficult to bear weight. I also have another symptom that I do not know is associated with itching after bathing or working out or getting hot, which is worst in the hands and feet.
Hello,
Welcome back to icliniq.com.
With normal ESR (erythrocyte sedimentation rate) and CRP (C-reactive protein), inflammatory arthritis is unlikely. Fibromyalgia is a likely possibility as inflammatory arthritis has already been ruled out. Another possibility in such a case is hypermobility of joints that could also contribute to such pain. Are your joints more flexible than usual? If you are still not sure, an MRI of the knee joints will confirm the presence or absence of arthritis.
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Rheumatology
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