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Q. I am not clear with the diagnosis of my mother's condition. Please clarify.

Answered by
Dr. Anshul Varshney
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Nov 17, 2015 and last reviewed on: Feb 21, 2019

Hi doctor,

Five years ago my mother was diagnosed with fibromyalgia. I think she also has rheumatoid arthritis. For the past five years, she was managing the pain with anti-inflammatory medicine, Lyrica, Mythycobal, Voltaren injections, herbal creams, etc. You can see the veins in her hands popping out. I also realized that the pain has got worse now.

For about 12 months the doctor put her only on Prednisolone 5 mg/day and painkiller when necessary. She was fine till last month but the pain increased in her hands now. In the daytime she is fine and the pain starts mildly in the evening. When she lies down in the bed she gets electrical tingling in her legs by which her sleep gets disturbed. She has undergone several tests last week and I attached them for your reference. She did not consult a rheumatologist yet. What medication can I give to reduce the inflammation and cure her? Her ESR, CPR, and ANA are quite high. The pain in her hands and the tingling in her legs at night are agonizing her life. Kindly provide your expert advice.

#

Hi,

Welcome to icliniq.com.

First of all your mother does not have rheumatoid arthritis or fibromyalgia. From her reports (attachment removed to protect patient identity) I found that she has connective tissue disorder and the most possible diagnosis would be systemic lupus erythematosus (SLE). The joint pain, high ESR (erythrocyte sedimentation rate), CRP (C-reactive protein), positive ANA (antinuclear antibody) and response to Prednisolone favors the diagnosis of connective tissue disorder.

She definitely does not have functional pain which occurs in fibromyalgia. Her pain and suffering are very true.Now to help you better I need some more details:

  1. Since how long is she suffering from all these? Is there any frequent reddening of eyes?
  2. Does she suffer with oral ulcer or any rash over the nose or cheek after sun exposure?
  3. Did she have any past history of heart and lung issues?
  • I would also like to know if her anti-ds DNA (anti-double stranded DNA) test has been performed?

Revert back with the answers for the above questions to a rheumatologist online --> https://www.icliniq.com/ask-a-doctor-online/rheumatologist

Hi doctor,

She is suffering with this condition for past five years. In the first two years, the pain hit her ankle, then moved to the neck, then the wrist and so forth. It started when my dad was a kind off paralyzed and she took full care of him. She does not suffer with any frequent reddening of eyes. She denies oral ulcer and rash on sun exposure. There is no relevant past medical history of note. The anti-ds DNA test has not been done yet.

#

Hi,

Welcome back to icliniq.com.

  • Please check her anti-ds DNA test in a short period and the laboratories which perform ANA may also perform anti-ds DNA.
  • She needs Prednisolone for the disease activity control. Though it has various side effects, it is essential. She should also be started on Hydroxycholoroquine Sulfate (HCQS). This drug helps in long-term.
  • Now for acute pain she would require anti-inflammatory painkiller like Etoricoxib.
  • During the winter or during the acute painful attacks she might require treatment with a single shot of intramuscular Methylprednisolone that gives pain relief for 2-3 weeks. So in short she needs steroids at present.
  • In fact at big centers we also use monoclonal antibody like Rituximab which is costly but helps a lot in controlling the disease activity. So at present she should see a doctor, an internal medicine specialist (MD in Medicine) and share my opinion.

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


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