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Undergoing replacement therapy for low IgG. Have pain in chest and foot. How to relieve the pain?

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Hi I have had chest and foot, finger and ankle pain for years, it never stops. I seem to have PSA and Gouty Arthritis (there is no break in the flares - it MUST attack something) there is almost always synovial of gouty crystal involvement - but my uric acid can be low and I still have an attack - I now have low IgG and am undergoing replacement therapy for this - what is the best drug for me to treat my constant joint pains - I need to be mindful that I already have immune deficiency, so i need to balance turning off the immune system with my risk of exposure due to low Immunoglobulans? I have tried. Allopurinol, Prednisone (always works), Indocid, Sulphasalazine (doesnt work), Planquil (seems to work), Methotrexate (does not work). I have inflamed lungs and they have become - squamous metaplasia - I just seem to be constantly inflamed ever since I had an Immunization needle I can no longer work as my lungs are damaged - i often get infections and I ALWAYS have joint pain
Posted Sun, 24 Nov 2013 in Lupus
Answered by Dr. Shruti Rijhwani 20 days later
Brief Answer: Follows . Detailed Answer: Dear Sir, Thank you or posting your query on XXXXXXX Well looking into the problem I would like to tell you that there is different joint involvement in these two groups . Psoriatic arthritis involves the DIP joint more and gout will involve the toe joints . so the distribution is entirely different . Psoriatic arthritis will not come in attacks . I think you need to see a rheumatologist because physical examintion is needed to determine the presence of synovitis . Your routine CBC, ESR , CRP , RF , Anti CCP antibody , ANA needs to be done . Demonstration of crystal in joint will be specific for gout . An HRCT chest to look for ILD changes . In my opinion you need medical care at earliest . Only after the diagnosis treatment guidelines will be suggested . Take care. Dr. Shruti
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Follow-up: Undergoing replacement therapy for low IgG. Have pain in chest and foot. How to relieve the pain? 1 hour later
I dont understand that you say PSA does not come in attacks, it is well documented that PSA has flares... granted I can usually tell the difference between PSA and Gout becasue the Gout comnes on almost overnight and is usually just in the toes - however you can get uncontrolled gout in other places right? I am already seeing Rheumo - however he is quite old, and not up to date with Biologic Treatments - the problem I have is that I dont know which drug or biologic drug is best suited for me - most seem to lower immune response - but I already have a low immune response and they are trying to increase the response because I have low igG - I have intravenous infusons to increase my IgG however this makes the PSA worse. ANA - always seems normal - SLE is negative, So is R Factor Blood Count is usually reasonably ok ESR is usually a bit high CRP is normal unless huge attack, this is even when I have chest wall problems and Gout. I hjave had aspirated jints before and they often find urate crystals, but MRI's suggest more likely to be connective tissue disease as synovial involvement is common - What is Anti CCP antibody - I have not had this tested? What are ILD changes? I have had 6 CT scans due to the squamous metaplasia in my airways and the pain, they never find anything too much wrong - they just see flluid at the bottom of lungs and a lot of inflamation - Biopsies of airways always shows chronic Inflamation of lungs and airways. My whole body seems to suffer inflamation of some kind and has done since immunisation 8 years ago - I am just trying to find a drug that will help with PSA but not affect my already reduced IgG levels? Sulphasalazine seems to lower my IgG even further and I get too many infections
Answered by Dr. Shruti Rijhwani 13 minutes later
Brief Answer: Follows. Detailed Answer: Dear sir, Thanks for reverting back . By saying that Psa does not come in attacks I meant that it will not resolve completely , some inflammation will be there and yes flares are very common. Anti CCP is a specific test for rheumatoid arthritis because sometimes it is very difficult to differentiate between two . ILD means interstitial lung disease but since you have had CT Scans earlier also it would have got picked up . We fairly have a good experience with biologics but you are right in saying that all of them with no exception supress the immune system because there basic mechanism of action is to supress the immune system as all these are autoimmune conditions in which the bodys immunity turns against its own system . Methotrexate is a good drug if you can tolerate that. Dr. Shruti
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