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Diabetic. Experiencing fatigue, loss of weight, pain in shoulders and knees and numbness and swelling in feet. Rheumatoid arthritis. Cure?

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Practicing since : 1999
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present complaints:
Loss of weight and appetite X 5 months. Has lost 9 kg in the last 3-4 months
Increased fatiguability X 5 months
Pain in the shoulders and knees. There is a huge problem getting up and sitting down.
Numbness in the feet X 5 months
Swelling in the feet X 5 months

Known diabetic X last 8 years. He had a frozen shoulder this December for which he received physiotherapy. It is slightly better now. Neuropathy in the feet has been diagnosed. Dry eyes , more so on the right side. He was put on long term ocular steroids after which he developed an eye infection. Following this, steroids were discontinued and he's currently receiving Systane and Genteal ointment.
Known case of psoriasis for >20 years. Flared up after development of diabetes. Mainly restricted to the lower legs. While it is not such a big problem, he does use an ointment when it flares up.
Known case of rheumatoid arthritis for 4 years. Started off with affecting the knees, shoulders and wrists (B/L involvement).
Treatment and reports are attached.

Thanks in advance
Posted Sun, 7 Jul 2013 in Lupus
Answered by Dr. Divya Agarwal 1 hour later
It seems like he is suffering from severe RA, and the severity of the problem is being aggravated by his diabetes.
the disease activity is high which I can gather from a high ESR and CRP, and also the high number of tender and swollen joints.
sometimes an active disease can cause problems like increased fatigue and weight loss.
the numbness and swelling in feet is probably related to his diabetes.
pain in shoulders and knees is related to the RA and also may be to secondary Osteoarthritis of the knees.

from his prescription he is on full dose of disease modifying drugs.
but injectable methotrexate has been added recently so we should give it time at least 6 weeks.
also hydroxychloroquine may be added, in such conditions in doses of 200 mg.

If even after 6 weeks the problems are not getting solved then we generally opt for drugs called biologics.
these are targeted drugs , some of which are remicade and enbrel .
these are stongly recommended in these type of situations.
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