Why do I have joint pain, back pain, depression, gastric irritation, and headache since a long time?

Question

Hello doctor,

Since childhood, I have experienced joint pains. I had food aversion and was taken to the ER once for fainting with a high fever. I developed food allergies, severe joint aches, chest pains, depression, and anxiety as an adult. Now that I am 54 years old, my depression is somewhat managed, and I have seen specialists. I lost my job eight years ago due to hypothyroidism. Now I feel like I cannot remember much and cannot reason well as I once did. I also have GI and periodontitis that keep me home (embarrassing gas and halitosis). I am menopausal and have fibroids and hirsutism. Some symptoms improve with time and then come back, like back pain, headaches, and joint pain. My current medications include:

Liothyronine 5 mcg.
Levothyroxine 112 mcg.
Omeprazole 40 mg.
Duloxetine 30 mg.
Cetirizine half a tablet for allergy and dryness.
Hydroxyzine for insomnia.
Iron supplements.
Montelukast 30 mg.
Vitamin D 50,000 IU weekly.
Multivitamins.
Tylenol one tablet daily.
Statins for high cholesterol and triglycerides.
Repatha.
Prozac.
Wellbutrin.
Mobic.

My protein electrophoresis test results show an elevation in alpha-2 globulin, ESR, and CRP values. An oncologist ruled out multiple myeloma. However, my hemoglobin is low sometimes, and so are my CO2 and chloride. In addition, I have numerous allergies, anemia, asthma, tremors, central hypothyroidism, sleep apnea, pre-diabetes, periodontitis, chronic fatigue, depression, joint pain, IBS, weakness, and memory problems. What do you think is going on with me?

Answer 1

Hello,

Welcome to icliniq.com.

I went through your reports and investigations (attachments removed to protect the patient's identity). It seems like you have polymyalgia rheumatica. I would suggest a single intramuscular dose of Depo-Medrol (Methylprednisolone Acetate) 40 mg. If the response in symptoms is more than 50 %, that will confirm the diagnosis and ease further management.

Regards.

Answer 2

Hello,

Welcome back to icliniq.com.

If you have had the problem for decades, I believe it cannot be a serious illness because no serious illness will stay silent for decades. Polymyalgia causes pain and elevation in the ESR (erythrocyte sedimentation rate). If ESR were normal, fibromyalgia would have been a better diagnosis. PMR (polymyalgia rheumatica) is generally a disease that occurs after 50 years, as you said. I am sure there is nothing wrong with one injection of Depo-Medrol, or you can start Duloxetine 20 mg and increase the dose after two weeks for FMS (fibromyalgia syndrome).

Regards.