Q. I have seronegative arthritis with unbearable joint pain in the night. Please help.

Answered by
Dr. Naval Mendiratta
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on Jun 09, 2020

Hello doctor,

I have seronegative inflammatory arthritis with ana positive. Joint pain especially at right knee shoulder joints MTP IP joints. Unbearable in the night for the last three months relieved with NSAID (non-steroidal anti-inflammatory drugs) patient cannot walk chairbound with in situ catheters for more than four years.

I am taking Ultracet if pain unbearable, few days back I have taken Injection Kenacort 60 mg IM on the advice of rheumatologist with some relief, but again pain resurfaced. Apart from that patient is on Apixaben 2.5 daily, Mirabeg 50, Soliton 20 and Donezepil 5, Vitamin C 1 gm daily. No BP, and DM issue. I am taking inhaler Laba with corticosteroid for long.



Welcome to

I have gone through your reports and history (attachment removed to protect patient identity). There seems to be some inflammation going on in the blood reports and with a diagnosis of previous arthritis, it looks like it is coming back again.

Does rheumatologist did not want to start on Methotrexate or any other DMARD? Are you not on any medications for the CA prostate? Any other symptoms of oral ulcers, dry eyes, or dry mouth? Do let me know these queries and I would advise you further.

Thank you doctor,

Rheumatologist planned to start DMRD after C3, C4 complement report. CA prostate is in remission. No medication or any intervention from 2009. No oral ulcer or dry eyes. Sometimes dry mouth but maybe for Soliten and it is not significant. Was it fine to give injection Kenacort? Until C3, C4 report comes should I continue with NSAID. Can it affect his kidney function? He was diagnosed with severe OA both knee.



Welcome back to

There is a lot of swelling in the pictures (attachment removed to protect patient identity). Yes, Kenacort (Triamcinolone) is to go for as it is the only drug that will help the current state. But I feel he will need short course oral steroids for three to four weeks to help him relieve of his pains. ANA (anti-nuclear antibodies) is positive but it looks more of seronegative arthritis only. My suggestion will be to start tablet Hydroxychloroquine 200 mg twice daily and Folitrax 15 mg once a week. That will cover ANA as well and Omncaortil 20 mg daily for seven days and then taper and omit over four weeks.

I hope this helps.

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