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Connective tissue disorder, swollen joint and hands - Online Doctor Chats

Date : 21-Feb-2012
User rating for this question
Very Good Posted in: Bones, Muscles and Joints
Answered by

General & Family Physician
Practicing since : 2004
Answered : 40 Questions
User :   I am a 39 year old recently healthy woman. I have seen 2 rheumatologists over the past year and both agree that there is "100%" chance that I have a connective tissue disease based on the physical exams alone. My nailfold/cuticle areas on all fingers are consistently puffy and red. Steady edema in my hands and feet. If my fingers become too cold, I feel ill afterwards. The Nailfold Capillaroscopy showed "significant capillary drop-out" according to my rheumatologist. My labwork shows negative RF, normal sed rates, etc., and only abnormal results were 2 subsets of (IgG) immunoglogulin deficiencies. Occult blood (+1) was found in the urine as well as presence of RBC (results: 4-10) An antinuclear antibody was detected in the ANCA screen (w/ reflex to titer) test, but the follow-up test (indirect immunofluorescence on Hep2 cells) was negative. I have had every known test for the major auto-immune diseases. All negative. I am "undifferentiated" and it's somewhat frustrating. My first symptom was 4 years ago and is now severe bilateral arthritis in MCP thumb joints for which I need surgery. Currently, the worst symptoms relate to Raynauds in my hands. The other (also rapidly progressing) symptom is joint/muscle stiffness (especially after being sedentary for a while). My hands/fingers ache the most when I am lying down, but my blood pressure seems to be normal when lying down however. I have had some upper and lower GI issues come and go over the past 20 years.I started taking Plaquenil about 3 weeks ago (after a baseline eye exam). Based on these facts, what is your best guess on a diagnosis? And how will I know when this disease has become chronic?
Doctor :   Hi
Doctor :   Let me read your query
User :   take your time
User :   I forgot. I also have developed shortness of breath. I am due for a PF exam.
Doctor :   May I ask you few questions to know about you? Please give your Age, Gender, Location, Occupation, Marital status, Height, Weight and Waist circumference.
User :   39 female Married 5'9" height. Weight is 135. Waist is 32"
Doctor :   Ok
Doctor :   I shall help you in your query
User :   are you familiar with rheumatology?
Doctor :   I am a General Practitioner, I believe I can help you within my expertise and If required I shall recommend a specialist.
User :   thank you
Doctor :   Since when are you having this joint swelling?
User :   All of my labwork is in front of me if you need any info
Doctor :   Is it present through out the day? pr any particular time ?
User :   right after the birth of my 2nd child about 5 1/2 years ago symptoms only in thumb joints
User :   raynauds on my right hand is much worse after a full day of use. I am rt. handed
User :   hands are red and swollen all the time but much worse after work
User :   morning stiffness the worse
Doctor :   Ok
Doctor :   Are you on any medication?
Doctor :   'now
User :   Plaquenil 400 mg
User :   Adderall 60 mg/day
Doctor :   Ok
User :   Maxalt for migraines and 25 mg Seroquel
Doctor :   Ok
Doctor :   Since when are you on this medication?
User :   this is all in my initial question
User :   3 weeks on Plaquenil
Doctor :   When was doctor consulted and refill for these medication?
User :   adderall 5-6 years
User :   i dont understand
User :   I see doctors all the time
Doctor :   When was your last doctor consultation and refill for these medication?
User :   6 weeks ago
Doctor :   Ok
User :   Can you refer me to a rgeumatologist maybe?
User :   rheumatologist
Doctor :   I suggest a multi specialty approach for you involving rheumatology, psychology, and behavioral therapy to overcpme yourproblem
Doctor :   you can also take benefit from our panel specialists
User :   I just need to chat with a rheumatologist
User :   how do I do that
Doctor :
Doctor :   visit this link to consulta rheumatologist
User :   thanks so much!
Doctor :   you can send your reports copies at
Doctor :   and we can send to the rheumatologist to go through them
Doctor :   and help you better
Doctor :
Doctor :   visit this link to consult a psychologist to help you with the other symptoms.
Doctor :   is there anything else i can help you with?
Doctor :   Did you follow what I said? Please get back to me in case of doubts.
Doctor :   Are you there?
User :   I don't want to spend $40 after $15. Do you have any ideas on a diagnosis??
Doctor :   the specialist opinion will help you solve out your problem and also give you insight on what is happening.
Doctor :   the 15$ would be refunded back to you as your query was not solved here and you need a specialist only to answer your query
Doctor :   after the problem has been gone through by the specialist.
User :   thank you
Doctor :   you can proceed with the specialist opinion
Doctor :   as i said you would require a mulispeciality approach to solve your problem
Doctor :   have you followed what I have said?
Doctor :   please get back to me in case you have doubts.
Doctor :   Is there any thing else I can help you with?
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