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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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What Causes Joint Pain In Ankles And Knees?

I have a 26 yr old son who injured his ankle in March of this year. What turn out to be inflamed ligaments that connect his leg and ankle right in the heart of the ankle. Now and for the past 3 months, he has severe joint pain in both ankles, both knees and his shoulders. Also inflammation in his right elbow and both has are swollen and he s losing his ability to grip things. Diagnosis is perhaps RA and we had an appointment 3 weeks ago, but he was not able to walk into the Dr s office, even on crutches. He s been given steroids both in pill form and injections, but nothing seems to work. He was also diagnosis with ITP in 2006 and I m mentioning this because in less than 4 weeks his pallets went from 504,000 to 615,000, but no particular infection has been found. Was tested for Sickle Cell, Lupus and Gout, but no positive results. He is now only taking Diclofenac, 1 pill daily. What do you think the problem could be. He can not walk without crutches and even with them it takes anywhere from 30 minutes to an hour to get out and back into the house which normally would take 11 - 14 steps from his room to the vehicle which we park at the front door. Please any information would be greatly appreciated. My name is Gloria, my son is Shaun.
Tue, 1 Dec 2015
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Orthopaedic Surgeon 's  Response
Hello Gloria, welcome to healthcaremagic.com
Sorry to hear about your boy. there are few case reports in the literature of association of ITP and Rheumatoid Arthritis. However, these other conditions should also be kept in mind and ruled out
RA+systemic lupus erythematosus (SLE) [Ruled out]
Felty’s syndrome
RA with drug-induced thrombocytopenia
A various Laboratory test is required to rule out the same.
I also need few other answers from you about your son.
1) Is there any morning stiffness?
if yes how long does the stiffness lasts?
2) Is there involvement of joints of finger/hand/toes?
any associated swelling of the joints?
3) Detail about decreasing grip?
4) are there any feeling of tingling, numbness?
5) any visible wasting of muscles?
6) does he have any Respiratory difficulty?
7) Any part of upper or lower limbs with impaired sensation?
ITP with RA is refractory to steroid treatment in certain cases gamma immunoglobulin(IVIG), Immunosuppressant or even splenectomy is required.
To determine the cause, a detailed history along with physical examination and laboratory test are required. considering very few case reports in the literature regarding this disease my recommendation is for you to visit a Rheumatologist for your son's case.
Warm Regards
Dr. Sumit Chawla
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What Causes Joint Pain In Ankles And Knees?

Hello Gloria, welcome to healthcaremagic.com Sorry to hear about your boy. there are few case reports in the literature of association of ITP and Rheumatoid Arthritis. However, these other conditions should also be kept in mind and ruled out RA+systemic lupus erythematosus (SLE) [Ruled out] Felty’s syndrome RA with drug-induced thrombocytopenia A various Laboratory test is required to rule out the same. I also need few other answers from you about your son. 1) Is there any morning stiffness? if yes how long does the stiffness lasts? 2) Is there involvement of joints of finger/hand/toes? any associated swelling of the joints? 3) Detail about decreasing grip? 4) are there any feeling of tingling, numbness? 5) any visible wasting of muscles? 6) does he have any Respiratory difficulty? 7) Any part of upper or lower limbs with impaired sensation? ITP with RA is refractory to steroid treatment in certain cases gamma immunoglobulin(IVIG), Immunosuppressant or even splenectomy is required. To determine the cause, a detailed history along with physical examination and laboratory test are required. considering very few case reports in the literature regarding this disease my recommendation is for you to visit a Rheumatologist for your son s case. Warm Regards Dr. Sumit Chawla