What causes knee pain and swelling?

Patient's Query

Hi doctor,

I am 27 years old. I have knee pain in both the legs and it is paining alternatively for the past 1.5 years. Pain starts with swelling around the knee and stay for three to four hours and the pain will be at least once in one to two months. I feel like pinching with needle in the feet. I also get backbone pain in the early morning. I have consulted a specialist and he told to do the attached laboratory tests. I have ASO titer 800 IU/mL and I do not have any tiredness, headache, fever, history of jaundice, joint pain, etc. Please help.

Answered by Dr. Senduran N

Hello,

Welcome to icliniq.com.

I have noted your complaints and also gone through the reports carefully (attachment removed to protect patient identity).

You seem to have a preceding streptococcal A infection.

I would like to know if you had any history of skin or throat infection left untreated or treated ineffectively in the recent past.

Elevated ASO (anti-streptolysin O) titer, arthritis pain and swelling of both knees makes me think of rheumatic fever.

I suggest you to do an echocardiogram (echo) to rule out any heart involvement and follow up every one or two months.

Also, I suggest you to do the WBC (white blood cells), ESR - erythrocyte sedimentation rate, C-reactive protein (CRP), ASO titer and anti-DNAse B titer to be monitored every two weeks.

Secondary prophylaxis to prevent recurrent rheumatic fever episodes and rheumatic heart disease, if diagnosed.

I suggest you to take shots of Benzathine Penicillin G 1.2 million units for every four weeks or month may be for next three years.

Also, you seem to have mild anemia, for which I suggest you to take capsule Livogen-Z (combination of ferrous fumarate and folic acid) twice a day for one month. Consult your specialist doctor, discuss with him or her and take the medicine with consent.

Physical examination and detailed clinical history play a vital role. Hence, I suggest you to visit a rheumatologist or general physician in person for the betterment of your health.

Investigations to be done:

Anti-DNAse B and echocardiogram.

Probable diagnosis:

Rheumatic fever.

Treatment plan:

NSAIDs (nonsteroidal anti-inflammatory drugs) like Celecoxib 200 mg, Piroxicam 20 mg twice a day. It can help to reduce the symptoms of pain and swelling.

Regarding follow up:

For further information consult a general practitioner online.---> https://www.icliniq.com/ask-a-doctor-online/general-practitioner

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