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Hello Doctor. My Mother, Aged 50, Has Been Suffering From

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Posted on Fri, 21 Sep 2018
Question: Hello Doctor. My mother, aged 50, has been suffering from Joint pains for the past 4 to 5 years (at random intervals), specially in knees and shoulders. One year she might have nothing and another year, she has severe pain. This year, her pain is back after 1.5 years..with high intensity and affected her quality of life. We consulted an ortho doc who ordered for a series of tests. I have attached the report. In the report, we did find some abnormal values like high ESR, high CRP and deviations in blood count and liver function test. So the ortho doc referred us to a Rheumatalogist and he ordered another series of tests for investigations. After physically examining her, the Rheumatalogist suspects it be a chronic illness of the bone, specially knees and that it might have caused enough inflammation in the body for high ESR and CRP to occur. The previous doctor suspects multiple myeloma which he requested the new doctor to rule out, We are really concerned about abnormally high ESR and CRP values. She does not have anyother symptoms except joint pains, specially while using stairs, when standing up and other movements in general. Please check the reports advise about the possible cause.
doctor
Answered by Dr. Divya Agarwal (13 hours later)
Brief Answer:
Look for inflammatory causes

Detailed Answer:
Hi

After going through your reports and the symptoms that you have described I feel that her symptoms are consistent with osteoarthritis of the knee however since inflammatory markers like her ESR and her CRP are high and her albumin and globulin ratios are altered I suggest that we need to work her up to look for any other cause that could be contributing to her disease .

She requires a serum protein electrophoresis ,Urine Examination, a chest X Ray and an ultrasound for her abdomen .

In case all these reports are negative then we also need to look into another disease which can sometimes cause pain and stiffness in the regions of the shoulder and the hip girdle sometimes in the knees also this is called polymyalgia rheumatica .

In case she does not suffer from any major stiffness in the early morning which improves with exercise then the possibilities come down to osteoarthritis. Osteoarthritis is a degenerative diseases of the joints it is treated with joint injections and sometimes medications which cause regeneration of the cartilage. So this is how we should go about it .

Regards
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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Follow up: Dr. Divya Agarwal (2 days later)
Dear Doctor,

The Rheumatologist suggested a series of blood tests, Knee MRI and Chest Xray for further investigations. I have attached the reports here. We are yet to meet him as some two other test results are yet to arrive. Please review the results and tell us your views.

Also, I need your comments on Biologics injection that the Rheumatologist suggested for my mom. We didn't get enough details about it. Can I know what is it used for? Will it help in managing pain? Any known side effects?
doctor
Answered by Dr. Divya Agarwal (40 minutes later)
Brief Answer:
Results seem ok

Detailed Answer:
Hi
The results seem better than previously.
The ESR is high but her CRP is almost ok.
Rest of the results are ok and the MRI is consistent with osteoarthritis.
So that is my primary impression.
Biologicals are drugs which are targeted molecules used for rheumatoid arthritis.
However, since her tests for RA are negative these won't be required.
The chest x-ray is also broadly normal.
So I feel she will require treatment for OA and she should get better.
Regards
Above answer was peer-reviewed by : Dr. Kampana
doctor
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Follow up: Dr. Divya Agarwal (7 days later)
Dear Doctor,

The pending test results have come 2 days back and I've attached the results. When we showed it to the doctor, seeing the comments in Chest Xray (which I have already posted here), he wanted to do Chest HRCT to proceed with biologics injection for inflammatory arthritis. I have attached the HRCT report here. Please correlate your views.

Can you brief about 'interstitial lung disease' that has been mentioned in the report? Asper the report, does she have it? Is it dangerous? Will it be reversible once we have good control over arthritis?

We are planning to start Biologics injection for her since knee is totally damaged. Does biologics injection affect her lungs?
doctor
Answered by Dr. Divya Agarwal (47 minutes later)
Brief Answer:
Biologicals are generally prescribed after dmards

Detailed Answer:
hi
it is possible that the interstitial lung disease is interrelated to her arthritis.
that may also be causing high esr and crp.
I feel that a disease called sarcoidosis should also be ruled out by doing serum ace levels , although she doesn't have lymphadenopathy that is another cause of ild.
we generally give patients disease modifying agents before we go in for biologicals,because that is how the protocol works.
biologicals can have adverse effect on Ild,but we need to find out the extent of ild by doing a pulmonary function test with dlco.
regards

Above answer was peer-reviewed by : Dr. Remy Koshy
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Answered by
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Dr. Divya Agarwal

Rheumatologist

Practicing since :1999

Answered : 658 Questions

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Hello Doctor. My Mother, Aged 50, Has Been Suffering From

Brief Answer: Look for inflammatory causes Detailed Answer: Hi After going through your reports and the symptoms that you have described I feel that her symptoms are consistent with osteoarthritis of the knee however since inflammatory markers like her ESR and her CRP are high and her albumin and globulin ratios are altered I suggest that we need to work her up to look for any other cause that could be contributing to her disease . She requires a serum protein electrophoresis ,Urine Examination, a chest X Ray and an ultrasound for her abdomen . In case all these reports are negative then we also need to look into another disease which can sometimes cause pain and stiffness in the regions of the shoulder and the hip girdle sometimes in the knees also this is called polymyalgia rheumatica . In case she does not suffer from any major stiffness in the early morning which improves with exercise then the possibilities come down to osteoarthritis. Osteoarthritis is a degenerative diseases of the joints it is treated with joint injections and sometimes medications which cause regeneration of the cartilage. So this is how we should go about it . Regards