What can cause knee pain with swelling?

Question

Hi doctor,

I am 27 years old. I have had knee pain in both legs, and it has been painful alternately for the past one and a half years. Pain starts with swelling around the knee and lasts for three to four hours, and the pain will occur at least once in one to two months. I feel like pinching with a needle in the feet. I also get back pain in the early morning. I have consulted a specialist, and he told me 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.

Answer 1

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 make me think of rheumatic fever.

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

The treatment plan is as follows: 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.

Also, I suggest you take shots of Benzathine Penicillin G 1.2 million units every four weeks or a month, for the next three years. Also, you seem to have mild anemia, for which I suggest you take the 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 visit a rheumatologist or general physician in person for the betterment of your health.

Thank you and take care.

Regards