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Q. I have sharp pain in my ribcage, left knee and heels and could barely walk. Is this due to RA?

Answered by
Dr. Naval Mendiratta
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Nov 30, 2019

Hello doctor,

I am a 35-year-old male. I am not overweight or flat-footed. For a little while now I have been getting sharp pains on the top of my rib cage, elbows, my left knee and both of my heels. I have a sharp pain in my heels which lasted over a week and could barely walk. There are some days where my entire body aches. These pains come and go. There are times where the simplest task like changing a light bulb will make my arms tired, and walking up steps in my house make me feel like I just ran a marathon. My legs are tired and I am a little out of breath. Again, this does not happen all the time. I have not consulted a doctor yet because the pain comes and goes. My dad has lupus and as far as I know, no one but my father has it. I know your answer will be limited because you have not seen me, but do you think this could be RA? I am currently taking Cymbalta. Any help will be greatly appreciated.

Dr. Naval Mendiratta

Rheumatology
#

Hello,

Welcome to icliniq.com.

The sort of pain you are describing especially the heel one looks more of enthesitis that is the pain due to tendon inflammation. It can happen at various sites like the buttocks, heels, foot, rib area, lower back, and neck. Since none of your joints are involved, it does not look like rheumatoid arthritis. But considering enthesitis inflammation and your age group, it is always advisable to do inflammatory markers like ESR (erythrocyte sedimentation rate), CRP (C-reactive protein) and get tested for HLA B27 (human leucocyte antigen). I am not sure if anti-inflammatory work in your case, but when the pain happens you can try it. Also, check for your vitamin D levels once to be sure the fatigue is not due to its deficiency. Definitely, examination is superior to anything but, at least we can try to rule out serious causes from here.


The Probable causes:

Enthesitis related arthritis.

Investigations to be done:

ESR, CRP, HLA B27.

Differential diagnosis:

Vitamin D deficiency.

Probable diagnosis:

Enthesitis related arthritis.

Treatment plan:

Anti-inflammatory(Celecoxib during the pain attacks).
Vitamin D supplementation.

Preventive measures:

Regular exercises, weight reduction.

Regarding follow up:

Do let me know the blood tests when you get it done and also the response of anti-inflammatory.


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