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Experiencing pain all over body. Blood test normal. MRI done. What Is the disease called?

Nov 2013
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Practicing since : 1994
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Hi, I hope you can help me. Last September, my husband woke up in excruciating pain in his shoulders and hamstrings. The pain has continued but in different areas, sometimes in his head, sometimes in his hands, feet, ankles and knees. He has been in pain ever since. He has seen a rheumatologist and a neurologist and neither can make a definitive diagnosis. His rheumatologis believes he either has rheumatoid arthritis or lupus, but his blood work does not reflect that. His neurologist disagrees but cannot give an explanation of what it might be. He had an MRI of the brain w, w/o contrast and his finidings were: microvascular ischemic white matter disease, but only a single tiny focus of T2. I know you cannot diagnosis him over the computer, but what do you think might be wrong with him? It has been 5 months and no diagnosis. His hands started swelling about 2 weeks ago and very painful, he has no energy and it is difficult for him to lift a 10lb dumbbell. He was previously a bodybuilder. Help!
Posted Fri, 1 Mar 2013 in Bones, Muscles and Joints
Answered by Dr. Sudhir Kumar 3 hours later

Thank you for posting your query.

I can understand the discomfort your husband is facing on account of pain, and also as no definite diagnosis has yet been made for his symptoms.

As I can see, the main symptoms are pain in joints & muscles, along with weakness.

Regarding the diagnosis of rheumatoid arthritis, if the blood tests are negative, it could be seronegative rheumatoid arthritis (RA). But I do not think the clinical picture is like RA. In RA, mainly small joints of hands & feet are affected, with swelling, and morning stiffness.

I presume serum Uric acid is normal, as high Uric acid can also lead to joint pains.

The most likely diagnosis could be fibromyalgia. In this condition, there are multiple areas of pains, including neck, back, hamstrings, etc. These areas are tender on applying pressure.

Regarding weakness, I hope a nerve conduction studies (NCV) and EMG have been done. This can help in determining if he has a neuropathy (nerve disease) or muscle disease. A blood test CPK can also help in finding out a muscle disease.

A deficiency of vitamin B12 can contribute to the weakness, so, it is worthwhile checking serum vitamin B12 levels, if not checked.

Regarding the MRI brain finding, it is not a specific finding. The most common condition where this can occur is migraine. However, in your husband's case, it is an incidental finding, and as of now, it can be ignored.

I hope it helps. Please get back, if you have any more queries.

Best wishes,
Dr Sudhir Kumar MD DM (Neurology) XXXXXXX Consultant Neurologist

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