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Have randomized body pain. All medical test done. What are the findings and cure to be done?

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Practicing since : 1985
Answered : 45 Questions
Dear doctor,

I am suffering from randomized body pain, initially lower back pain for last 5 months. I consulted one ortho. in XXXXXXX Hospital Noida, he got my Vit D3 levels checked n found my body deficient. He suggested me to have Cholecalciferol XXXXXXX D-360 with milk once a week and get exposed to plenty of sunlight which I followed religiously. Since I did not find much relief in pain, I consulted another XXXXXXX ortho. (surgeon) at District Hospital Noida, he got my other tests done, like Uric Acid, RA Factor, Calcium and Digital X-rays of DL Spine & LS Spine. After examining the reports, along with suggestions advised by former ortho., he advised me to have Calcium (with Vit-D ) tablets OSTOCAL-D twice daily after meals. He stressed that I should have ample amount of milk and milk-products. Additionally, he suggested three simple exercises for lower back.

To XXXXXXX my Vit D3 & Calcium deficiency, I googled and found some natural sources like seasame, carrots, dry plum, etc and started having them for last more than a month. For pain, I have been actively treating it with Hot water bottle fomentation. Now (after 8 weeks), my Vit-D3 leveles have come within sufficient limits. Back and body pain remained better for about a month but not gone completely, earlier my lower back used to pain so much while getting up from bed in the morning that I had to struggle for an hour or so to leave the bed but now that problem is vanished and I feel pain at the end of whole day (at night or after a prolonged set posture or after any stressful job or when I have to stand for sometime continuously especially while travelling in metro, etc) please advise. My joints (finger joints, wrist, knees, elbow, etc) use to pain while doing some stressful job like exercising, being in stooping position for few minutes, lifting something above my shoulder and bringing it down slowly in a repeated fashion for sometime like a mug of water while taking bath, or combing hair, or drying my hair with towel, etc, which I do not recall as I ever had these problems till an year back or so, rather I had been quite athletic and active doing physically stressful exercises and jobs.

Since last 10 days, I have been feeling that my body & joints pain has relapsed to square one (even worse than it started initially) Being a software engineer, my fingers in bad state are supposed to impact my job and I face difficulties in typing, gripping objects, etc. After checking my latest test reports of HLA B27, CRP, ESR, RA Factor, on latest appointment, my ortho. has advised me to take Indocap 75mg (2wice daily), Methotrexate 7.5 mg (once a week), along with old medication continued, as he found me to be HLA B27 positive (however, I have no heredity, both maternal & paternal, of arthritis or joint pain), kindly suggest if advised medication is fine ?

I am attaching all my test reports and prescriptions for your kind reference (file nomenclature has been done date-wise).

Also, please suggest best Rheumatologist in NCR (Delhi, Noida, Ghaziabad, Gurgaon) as I put up at Sector-51, Noida (UP) so that I could consult him asap.

Posted Sat, 2 Mar 2013 in Bones, Muscles and Joints
Answered by Dr. Praveen Jadhav 7 hours later
From your symptoms and test results, you appear to be suffering from either ankylosing spondylitis, reactive arthritis or psoriatic arthritis.

From your history, it is not clear if you are a male or female. Though possible in women, these ailments are more common in men.

You do need to consult a rheumatologist rather than an orthopedician. Though few in number, all big hospitals such as Apollo, AIIMS, etc will be having a rheumatologist on their panel. I am unable to recommend a specific rheumatologist in your area, but your family doctor can help.

The best medication for these conditions will be sulphasalazine rather than methotrexate. All other medications are either for symptomatic relief or supportive in nature.

All these conditions are chronic in nature, will give a slow response to treatment and will require long term, perhaps lifelong, medications.

A new breed of medications called BIOLOGICALS give an excellent and quick response. However, they are prohibitively expensive.

Hence please get in touch with a rheumatologist as soon as possible

Dr Jadhav
Above answer was peer-reviewed by
Follow-up: Have randomized body pain. All medical test done. What are the findings and cure to be done? 2 days later

Thanks for your valuable inputs. I consulted a rheumatologist, he has got my CRP test repeated (Result: Negative), TSH level (7.96 ulU/L), MRI of pelvis to look for sacroilitis (Result: No sacroilitis detected). Please find test reports attached. The rheumatologist has suggested me following medications:

1. Tab. Retoz 120mg once daily for 2 weeks, afterwards once every alternate day.
2. Cap. Pregalin-M 75mg once daily at 8 PM
3. Tab. Shelcal 500mg once daily
4. Calcirol XXXXXXX with milk once a month

Review after 1 month with results of CBC, ESR, SGOT & SGPT.

Can you please suggest if advised medication is fine ? Are there any side-effects of advised drugs ?

If no signals of arthritis is found within conducted test results (except HLA B27 +ve) then what could be the reason of back and joints pain (Note: Vit-D3 deficiency has been treated now) ? Can it be due to slightly higher level of TSH ?? Should TSH with levels 7.96 ulU/L be treated or is it insignificant that does not need to be treated ?

Do you suggest if I should consult any other specialist besides rheumatologist ? e.g. Neurologist, or general physician, etc. Kindly advise.

Thanks in advance.
Answered by Dr. Praveen Jadhav 4 hours later
I am sure the rheumatologist must have decided about the treatment after a careful examination. So trust that the treatment is correct.

In short term, retoz can give gastritis and heartburns. Pregalin can sometimes cause giddiness and drowsiness.

The mild elevation of TSH appears insignificant and doesnt warrant treatment right away.

The possible causes of your pain could be fibromyalgia, ankylosing spondylitis, and other rare causes as mentioned in the earlier answer. Sometimes it takes time for a rheumatological disease to evolve and diagnosis cannot be pin pointed at initial stages.
Above answer was peer-reviewed by
Follow-up: Have randomized body pain. All medical test done. What are the findings and cure to be done? 22 hours later
Dear doctor,

Thanks for your valuable inputs. You have mentioned that sometimes it takes time for a rheumatic disease to evolve, can you kindly advise how can rheumatic disease be curbed/prevented from being evolved if by any chance I am currently having it in initial stage ? Is there any refined/specialised test that can identify (rule out) rheumatic disease, if any ? Do I need to follow selective abstinence in my diet or I need to follow particular posture while sitting, walking, etc to prevent rheumatic ailments or joints pain ? Please suggest tests that should be conducted periodically to check/monitor evolution of rheumatic disease ?

Thanks a lot !
Answered by Dr. Praveen Jadhav 34 hours later
Unlike other diseases such as heart diseases or cancers, rheumatological diseases cant be prevented. That means that there is no precautionary measure to be done or avoided which can alter the precipitation of most rheumatologic diseases. Most of these diseases have a genetic bases.

Unfortunately there is no test which can predict the course of the disease. Development of new signs and symptoms are the parameters to be followed to track the course of the disease. Hence, it is best to consult a rheumatologist early when new symptoms develop, so that the effect of the disease can be diagnosed and treated early.
Above answer was peer-reviewed by
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