Dr. Anuj Nigam
Orthopedician and Traumatology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hi doctor,
Four years ago, my right knee suddenly started getting swollen. I could not walk, sit, or bend my knee, and there was extreme pain, warmth, and redness in my knee. Finally, after almost four months of struggle, I went to an orthopedic surgeon, who told me that my RA factor was negative and I only had knee effusion. He gave me medicines, and I got relief. But after one month, the same problem arose slowly, and day by day, it was increasing. I was so busy with my studies that I thought I was overthinking, so I decided not to worry. After that, slowly, my pain got reduced, but the swelling has continued till today for almost four years. I have taken Methotrexate 15 mg once a week for one month, one tablet a week, Methylprednisolone 8 mg once for 15 days, Etoshine 90 mg once a day, Cartiquine 200 mg twice a day, Defzo 6 mg thrice a day for five days, twice a day for next five days and once a day for next five days. But for one year, I have also been experiencing pain in my right heel. Now, my RA factor is positive which is 59, C-reactive protein was 20 mg/L, uric acid, and thyroid levels were normal, and my ANA report was negative. For almost one month, I also had pain in my lower back, and I could not bend my back correctly when I stood and started to feel pain after five minutes of sitting. Please help me.
Hello,
Welcome to icliniq.com.
I read your query and understand your concern. From the reports attached (attachments removed to protect the patient's identity), I can understand the pain you are going through at such a young age. The elevated rheumatoid factor indeed points towards inflammatory arthropathy, and you did very well in referring to a rheumatologist to start the rheumatoid treatment. Unfortunately, rheumatoid treatment is a lengthy treatment. However, the elevated platelet levels and discoloration of the legs are a little problematic. Upon looking through your X-ray, there appears to be some black circular structure that can be of any nature, including a tumor or a cyst, or it might be just an artifact of the X-ray machine. Any suspicion needs to be cleared off at the earliest. I suggest you go for a MRI (magnetic resonance imaging) of the knee joint and rule out any other causes of pain and swelling other than rheumatoid. Kindly follow me back with all your reports and MRI reports as well.
Thank you.
Patient's Query
Hi doctor,
I have attached my files.
Hello,
Welcome back to icliniq.com.
I read your query and can understand your concern. The reports (attachments removed to protect the patient's identity) are under normal limits. Recent reports show a decrease in CRP (C-reactive protein) and ESR (erythrocyte sedimentation rate) levels it, shows that the anti-rheumatoid medicines you are taking are working well. Uric acid and ASO (antistreptolysin O titer) are normal, which are usually high in other types of knee joint disease. However, as suggested earlier, I recommend you have an MRI of the knee joint soon so we get everything for the final diagnosis.In addition, we need to revise the current treatment as you are on a higher dose of medications that may affect other body parts. I hope to see your MRI report soon.
Thank you.
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Orthopedician and Traumatology
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