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Dr. Andrew Rynne

Family Physician

Exp 50 years

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Have arthritis in fingers. Tested negative for autoimmune disorders. Which specialist should I consult?

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Dr. Ram Choudhary

Internal Medicine Specialist

Practicing since :2001

Answered : 2272 Questions

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Posted on Sat, 22 Dec 2012 in Medicines and Side Effects
Question: I am 31,white male, 6'3", 230 lbs. Starting about a year and a half ago I started developing arthritis in my fingers. I had previously had and still have gout attacks so I was under the impression that it was related to that. The arthritis remained and eventually intensified and spread to my wrists and further to just about all of my joints. I have tested negative for rheumatoid arthritis and autoimmune disorders and my CBC has come back normal, minus the high uric acid. I also tested normal for kidney function. In addition to the arthritis I have bowel problems, constipation and when I do have a movement its often watery and thin. It should also be noted that I have had an inguinal hernia for about the past 5 years. In addition to the others symptoms noted, I also have what appears to be a ganglion cyst on the top of both hands near the wrist, moderate to severe fatigue and as noted earlier I'm very susceptible to gout attacks. I suppose it should also be mentioned that when I urinate in the mornings I sometimes get severely fatigued to where my heart is beating faster and I feel as if I might pass out. I get the same feeling when I take a long hot shower. Lastly, within the last three or four years I get cold easier, I first attributed this to weight loss (about five years ago I lost around 100 lbs) but thought I'd mention it. I have an appointment set up with a rheumatologist in late December although I don't know if I'd be better served going to an endocrinologist or someone else. Any advise or help will be greatly appreciated. Thanks
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Answered by Dr. Ram Choudhary 9 hours later
Hi XXXXXXX
Welcome to healthcare Magic!
Your poor health stands in stark contrast to your fabulous height and bodily feature, it is strange!
It seems your primary and most befitting problem is the Gout and the persistent hyperuricemia. Secondary to it's unabated high levels you have developed the involvement of the other joints. I would advise that you should get uricosuric drugs and the drugs to prevent formation of excess uric acid. There are good drugs available to handle this problem but must be taken under consultation of a physician of your locality. The options are Allopurinol or febuxostat. these medicines are needed to be taken regularly till your levels of urate come down to below normal and you are asymptomatic. Then you can switch to lower maintenance doses.
I also agree with the idea that you ate not having rheumatoid arthritis. The problem of inguinal hernia is not related to your poor health and if problematic then must be solved surgically. The ganglions are sporadic growths around tendons and are more common with inflammatory states in body.
Your poor general health related symptoms like fatigue and associated problems may be related to the excess urates, I would suggest to get a correction of urate levels and I hope most of the problems would subside in the sequence.
You should take a good soft laxative like Lactulose 20ml at bed time to regularise the bowels till you feel better about bowel movements.
I hope the advise would be informative and useful for you.
Take Care!

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Ram Choudhary 1 hour later
Dr. thank you for your answer. One question, would there be any underlying issue that could be causing my gout attacks and constant arthritis? Also do you feel like my arthritis is caused by my hyperuricemia? Ive taken allopurinol before for about a month with no athritic relief. My goal obviously is to counter whatever is causing the arthritis so that i can go about my normal activites again. There was one other symptom i forgot. When i put any strain on my muscles they start to shake. Thank you again for your imput.
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Answered by Dr. Ram Choudhary 51 minutes later
Hi XXXXXXX
Welcome back to Healthcare Magic Physician's Desk!
Some persons tend to make more uric acid just due tu more formation of it because the have a metabolism of that type due to genetic make up.
Other causes should be ruled out like any blood malignancy, drug induced, or chronic illness.
it would be a good screening test to Get a CBC, LFT, RFT and a Peripheral Blood Smear reporting to have a base line insight.
Allopurinol for a month is a very short duration, that is the time when the drug will start to show it's effect in the body. You should have taken it longer rather continued till you get normal urate levels. Your arthritis is related to uricemia till we can prove it to be present with normal urate levels.
Wish you a great health!
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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