I have pain in the bones, joints of hands and feet especially in the morning upon waking up. It has been consistent for the past couple of months. Please help.
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I have gone through the reports (attachment removed to protect patient identity). There is a high RA factor and low vitamin D. I would like to take a few more details on the history part. But it would be better if someone can examine the joints as it is a long treatment which patient will need. So she should be examined properly before commencing the drugs for it.
Does she have early morning stiffness? If yes, then for how long? Any dry eyes or dry mouth? Any oral ulcers? Any hair fall? Any recent changes in mood with irritability? Any history of tending to forget things early?
Thank you doctor,
No morning stiffness but she has pain in her hands and feet that is stronger in the morning and lighter afterward. She has dry eyes and a little bit of dry mouth and no oral ulcers.
She has inherited hair fall for a long time but under control now. She has a change in her mood recently and is irritated easily with any problems or issues. And yes she tends to forget things a little bit recently.
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Well, as of the history and the blood reports I have drawn a conclusion. But you can once read on it and see if her symptoms correlate, because exact diagnosis does lie in the examination part, but at least we can start her on medications and see if it helps.
Blood reports say her RA (rheumatoid arthritis) factor is high, but it is a known fact that it can be positive in 10 percent of the people without any symptoms. As ESR (erythrocyte sedimentation rate) and CRP (C-reactive protein) are quite normal, so the scope of inflammation seems low. But one must get the feel of joints to be sure it is not inflammation.
With dry eyes, dry mouth and joint pains there seems to be more like a predominance of Sjogren's syndrome than rheumatoid arthritis. RF can be positive in both conditions, but again since ESR is normal, it goes a little against it as well.
My main diagnosis does go in favor of a condition called fibromyalgia which has pains, fatigue, forgetfulness, irritability. You can read about this condition and see if it fits in her symptoms. There is no diagnostic test for this, but we normally conclude it if there are no other problems found.
So start her on Vitamin D. For fibromyalgia, she can start on Pregabalin M 75 mg at night. But once you read, you can revert to me if it fits in her symptoms. But it is definitely not rheumatoid arthritis.
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