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Dr. Andrew Rynne

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History of eosinophilic esophagitis. Feeling fatigue, nausea and joint pain. Any suggestion?

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Internal Medicine Specialist
Practicing since : 2000
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My 12 year daughter has history of eosinophilic esophagitis. Last blood test showed eosiniphils at 15%. Chronic complaints about fatigue, joint pain in wrist and ankle, nausea, poor weigt gain (Currently 62" and 88#) and has developed hard nodules on small joints of fingers. Any suggestions for testing would be helpful -seeing GI doctor and hand surgeon next month.
Tue, 11 Dec 2012 in Asthma and Allergy
 
 
Answered by Dr. Sudhir 13 minutes later
Hello,

In my view her symptoms arise suspicion of autoimmune disease like rheumatoid arthritis.Multiple joint pain and skin nodules are commonly seen in this condition. I am arising this possibility in view of symptoms and it is always better to get this checked even on mere suspicion.

I would recommend to see a Rheumatologist sooner to confirm the diagnosis.Doctor might want to get few routine blood investigations and RA factor checked.
You can decide about seeing hand surgeon after this, if needed.

Apart form routine blood investigation and eosinophilic count, I don't think any test can be undertaken before seeing GI doctor.

Hope this answers your question.Please feel free to ask if there are doubts.

Regards.


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Follow-up: History of eosinophilic esophagitis. Feeling fatigue, nausea and joint pain. Any suggestion? 6 minutes later
Thank you - the hand was xrayed which showed no calcifications or changes to the joints themselves - more superficial nodules. Would there have been changes to xray if RA diagnosis?
 
 
Answered by Dr. Sudhir 12 hours later
Xray changes might not be obvious in first few attacks.Generally it takes time to develop these changes, initial stage is of joint inflammation without any residual changes in bones or joints.

In RA one would get changes of arthritis like sub-articular osteoporosis,reduced joint spaces,irregular articular margins, soft tissue calcification and deformity in advanced stages.But it's not that xray will always show all changes.

It's kind of spectrum of findings, which one can get on xray varying from normal to advanced deformity.

I would strongly recommend a visit to Rheumatologist.

Hope this answers your question.Regards.
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