Q. I have painful swelling of the joints for the last three years. Can you please help me?
Hi doctor,
I have had painful swelling of the joints for the last three years. It started on my right hip, then the right knee joint. Now I have a painful swollen right knee. I cannot sit, or walk fast. My family doctor prescribed the tablet Indometacin and then referred me to an Orthopedic doctor. They believed that this was arthritis, and now the rheumatology doctor has given them an appointment for the next month. I am on a low-purine diet and endocrine tablets. Can you help?
Hello,
Welcome to icliniq.com.
Seeing your weight, this might be early osteoarthritis. However, if there is swelling, we need to tap the knee and get the fluid. I suggest taking some laboratory tests to rule out rheumatoid arthritis-like ESR (erythrocyte sedimentation rate), CRP (C-reactive protein), RA (rheumatoid arthritis) latex turbid test, and anti-CCP (cyclic citrullinated peptide). Treatment of osteoarthritis is mainly weight loss and physical therapy.
Thank you.
Hi doctor,
Would you please discuss the possibility of different forms of arthritis (differential for my illness)? Would you please further discuss specific lab tests for each differential? I might have gout arthritis for the following reasons. I was a heavy raw meat eater for an extended time. The pain responds to the tablet Indometacin. I have a history of pain and swelling but only for just one week in different periods for the last three years involving my wrist joint, elbow, ankle, and feet-sole. Would you please list what laboratory tests I can do for gout arthritis? I am now on a low uric acid diet for one month. Can that affect the test for gout arthritis? Please see the attached laboratory test my family doctor send me. He ordered only rheumatoid factor and sediment. He did not order the uric acid test. Would you please tell me what you could order to diagnose me? Sorry for the confusion. My weight is 170 lbs, not 270 lbs. That was a mistake.
Hi,
Welcome to icliniq.com.
Arthritis can be defined as either mechanical (osteoarthritis, aging, fracture) or inflammatory (RA (rheumatoid arthritis), gout, etc.). A typical feature of inflammation is pain, usually at night, relieved by physical activity and exacerbated by prolonged rest. It responds well to anti-inflammatory tablets like Indometacin. It would help if you detected a level of inflammation. RA latex turbid test, anti-CCP (cyclic citrullinated peptide) for rheumatoid arthritis. Uric acid levels for gout though can be expected during an acute attack. Fluid microscopy to detect uric acid crystals on fluid from the knee is the most accurate test to diagnose it.
Thank you.
Hi doctor,
Can you tell me the specific blood tests I need to differentiate from rheumatoid arthritis or gout arthritis? Please discuss further how to manage it?
Hello,
Welcome back to icliniq.com.
It would help if you detected a level of inflammation. RA and CCP for rheumatoid arthritis, and uric acid level for gout, though it can be average during an acute attack.
Fluid microscopy is to detect uric acid crystal on fluid from the knee.
Management is different depending on the cause. I suggest a short course of tablet Prednisolone 20 mg daily for five days. It will do the job if it is gout. If it is rheumatoid arthritis, treatment is complex and involves immunotherapy.
Thank you doctor for the patience,
I am taking tablet Indometacin. Does that alter the laboratory result of RA, CCP, and uric acid? Should I stop tablet Indometacin?
Hi,
Welcome back to icliniq.com.
It does not affect the tests. Keep taking it.
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