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Suggest Treatment For Pain And High Uric Acid Levels
Question: Hello Doctor
I am 35 years old, no smoking/alcohol, normal eating habits (seldom junk food), 177 cm/75 Kg and normal shape. I work on computer for 5-7 hrs./day (Sometimes even more). I had been doing exercise (treadmill and weight training) thrice or four times a week. I am on antidepressant Bupropion 300mg/day for anxiety related issues for the last 18 months.
Few months back, I started feeling middle back pain (and couple of times very mild shock like feeling on moving my back). When I met a physiotherapist he suggested me exercise for back, I started it and the pain reduced after that it was just on and off. I remember correctly that while doing gym exercises sometimes I used to feel little pain/spasm in the middle of my palm, or in other joints but they were just temporary, may be for hours or a day (I just want to inform you and not relating to my present problem)
Now, I am facing pain in my several joints for more than a month from now. It is so painful (especially at late evening/night) that I am not able to move, walk or even sleep. I feel feverish sometimes due to this pain. Pain symptoms are:
Sharp - Knee, Ankle, Toe, Foot-base
Moderate– Hips, Right Shoulder, Middle Back
Mild –Wrists
Outset of this pain occurred around 10th July, I ran on treadmill about 10 Kms. on 2 consecutive evenings (total 20), took bath and turned on AC to sleep as I was feeling exhausted. On third day I felt stiffness in all the joints (hips and below). I ignored as I am not used to the distance I had run, I run only 4-5 Kms usually. On subsequent days it started paining and even getting exacerbated and pain in wrist also started. When I consulted to couple of Ortho experts they asked for some X-rays and lot of expensive blood tests (attached prescriptions/reports). In a nutshell, only my Vitamin D3 is low (16.9), though other tests CRP +ve (2.71) and ESR (43) are also out of range but doctor says these are not specific tests (checked for inflammatory process). Other tests (ANA, RA factor, HLA-B27, Anti-CCP etc.) are normal.
They gave me some Calcium and Vit. D3 supplements, Pain-killers, Anti-inflammatory, ointments etc. and one Doctor also gave me Febuxostat for uric acid, I am not sure why he gave me that as it was 6.5 and between normal range (3.4 – 7.2)
Now, I need your advice on few things:
1. I have seen couple of orthopaedic experts and line of treatment of every doctor is different, one is suggesting to go for whole spine MRI, another one is asking me to take anti-inflammatory and other uric acid lowering drugs for 2 months with some food precautions and then go for some test. I am confused to whom I should follow, is it really a case of gout or something else. Please suggest.
2. The leaflet of my anti-depressant drug says that it can have side effect of arthralgia, myalgia, muscoskeletal pains etc. and I have also read on net that this is a known side-effect of this drug. Even people on some forum have given their experiences and symptoms which are exactly same as me. However, my psychiatrist has different opinion and he says if the medicine had any side-effects, I would have complained long back. He says that even these pains could also be psychosomatic.
3. I had been taking lot of protein till February in the form of Whey protein supplement powders and natural sources. I also started having lot of non-veg (eggs, chicken), earlier I was vegetarian (no eggs/chicken). Can this problem be a manifestation of these changes in diet
PS:- In February, my cholesterol was boundary-line high (203) and TG was also elevated, both just came back to normal in May with diet changes and exercise.
Please help me with your advice about medicine or test (if required). I don’t want to go for any un-necessary tests and medicine; I am ok with any life-style/eating habits changes.
Thanks
XXXX
I am 35 years old, no smoking/alcohol, normal eating habits (seldom junk food), 177 cm/75 Kg and normal shape. I work on computer for 5-7 hrs./day (Sometimes even more). I had been doing exercise (treadmill and weight training) thrice or four times a week. I am on antidepressant Bupropion 300mg/day for anxiety related issues for the last 18 months.
Few months back, I started feeling middle back pain (and couple of times very mild shock like feeling on moving my back). When I met a physiotherapist he suggested me exercise for back, I started it and the pain reduced after that it was just on and off. I remember correctly that while doing gym exercises sometimes I used to feel little pain/spasm in the middle of my palm, or in other joints but they were just temporary, may be for hours or a day (I just want to inform you and not relating to my present problem)
Now, I am facing pain in my several joints for more than a month from now. It is so painful (especially at late evening/night) that I am not able to move, walk or even sleep. I feel feverish sometimes due to this pain. Pain symptoms are:
Sharp - Knee, Ankle, Toe, Foot-base
Moderate– Hips, Right Shoulder, Middle Back
Mild –Wrists
Outset of this pain occurred around 10th July, I ran on treadmill about 10 Kms. on 2 consecutive evenings (total 20), took bath and turned on AC to sleep as I was feeling exhausted. On third day I felt stiffness in all the joints (hips and below). I ignored as I am not used to the distance I had run, I run only 4-5 Kms usually. On subsequent days it started paining and even getting exacerbated and pain in wrist also started. When I consulted to couple of Ortho experts they asked for some X-rays and lot of expensive blood tests (attached prescriptions/reports). In a nutshell, only my Vitamin D3 is low (16.9), though other tests CRP +ve (2.71) and ESR (43) are also out of range but doctor says these are not specific tests (checked for inflammatory process). Other tests (ANA, RA factor, HLA-B27, Anti-CCP etc.) are normal.
They gave me some Calcium and Vit. D3 supplements, Pain-killers, Anti-inflammatory, ointments etc. and one Doctor also gave me Febuxostat for uric acid, I am not sure why he gave me that as it was 6.5 and between normal range (3.4 – 7.2)
Now, I need your advice on few things:
1. I have seen couple of orthopaedic experts and line of treatment of every doctor is different, one is suggesting to go for whole spine MRI, another one is asking me to take anti-inflammatory and other uric acid lowering drugs for 2 months with some food precautions and then go for some test. I am confused to whom I should follow, is it really a case of gout or something else. Please suggest.
2. The leaflet of my anti-depressant drug says that it can have side effect of arthralgia, myalgia, muscoskeletal pains etc. and I have also read on net that this is a known side-effect of this drug. Even people on some forum have given their experiences and symptoms which are exactly same as me. However, my psychiatrist has different opinion and he says if the medicine had any side-effects, I would have complained long back. He says that even these pains could also be psychosomatic.
3. I had been taking lot of protein till February in the form of Whey protein supplement powders and natural sources. I also started having lot of non-veg (eggs, chicken), earlier I was vegetarian (no eggs/chicken). Can this problem be a manifestation of these changes in diet
PS:- In February, my cholesterol was boundary-line high (203) and TG was also elevated, both just came back to normal in May with diet changes and exercise.
Please help me with your advice about medicine or test (if required). I don’t want to go for any un-necessary tests and medicine; I am ok with any life-style/eating habits changes.
Thanks
XXXX
Brief Answer:
Discussed issue based on information sir
Detailed Answer:
Hello XXXXXXX and welcome.
Thank you for writing to us.
I have gone through your query with diligence and would like you to know I am here to help. Thank you so much for all the information you have provided, you have really given a doctor enough information to work with and with all the tests already conducted I am not here to advice any further investigations, but only to advice you what I think is wrong with you and what should help.
1. Your uric acid level was within the normal range, but closer to the upper limit of the normal range. It is also possible that the level was normal when measured, and has been fluctuation. With the number of joints involved, this is most probably either a bone condition like arthritis or an elevated serum condition that is causing all the joints to be involved. As RA factor has returned a normal result, the current indication is towards uric acid to be the cause.
2. If this was a side effect you would have experienced it much earlier as correctly mentioned by your doctor. But if it were psychosomatic, it would have only resulted in pain and not an elevation is CRP or ESR levels which clearly indicate inflammation which is quite obviously present.
3. Uric acid levels are raised by an improper diet and quite a lot by non-vegetarian food, especially red meat. As you have started to experience these symptoms recently, especially a while after the initiation of a non-vegetarian diet I strongly suspect the cause to be uric acid.
As you see from the above 3 discussions, all three of them point towards the possibility of the cause being an elevated uric acid level that is causing an irritation despite it being within normal limits at times. In my opinion, you should take the uric acid-lowering medications and go about the dietary restrictions and observe the changes for 2-3 months. If you seem to be recovering, then the cause is clear.
I think you should recover with such changes sir. I also hope you find my response helpful and explained in a manner best understood by you sir. Please feel free to write back to me for any further clarifications, I would be more than happy to help.
Best wishes.
Discussed issue based on information sir
Detailed Answer:
Hello XXXXXXX and welcome.
Thank you for writing to us.
I have gone through your query with diligence and would like you to know I am here to help. Thank you so much for all the information you have provided, you have really given a doctor enough information to work with and with all the tests already conducted I am not here to advice any further investigations, but only to advice you what I think is wrong with you and what should help.
1. Your uric acid level was within the normal range, but closer to the upper limit of the normal range. It is also possible that the level was normal when measured, and has been fluctuation. With the number of joints involved, this is most probably either a bone condition like arthritis or an elevated serum condition that is causing all the joints to be involved. As RA factor has returned a normal result, the current indication is towards uric acid to be the cause.
2. If this was a side effect you would have experienced it much earlier as correctly mentioned by your doctor. But if it were psychosomatic, it would have only resulted in pain and not an elevation is CRP or ESR levels which clearly indicate inflammation which is quite obviously present.
3. Uric acid levels are raised by an improper diet and quite a lot by non-vegetarian food, especially red meat. As you have started to experience these symptoms recently, especially a while after the initiation of a non-vegetarian diet I strongly suspect the cause to be uric acid.
As you see from the above 3 discussions, all three of them point towards the possibility of the cause being an elevated uric acid level that is causing an irritation despite it being within normal limits at times. In my opinion, you should take the uric acid-lowering medications and go about the dietary restrictions and observe the changes for 2-3 months. If you seem to be recovering, then the cause is clear.
I think you should recover with such changes sir. I also hope you find my response helpful and explained in a manner best understood by you sir. Please feel free to write back to me for any further clarifications, I would be more than happy to help.
Best wishes.
Note: For further queries, consult a joint and bone specialist, an Orthopaedic surgeon. Book a Call now.
Above answer was peer-reviewed by :
Dr. Raju A.T
Answered by
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