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Dr. Andrew Rynne

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Suffering from rashes, joint pain and fatigue. Could this be autoimmune disorder?

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Dr. Sujoy Khan

Allergist and Immunologist

Practicing since :1999

Answered : 584 Questions

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Posted on Fri, 6 Dec 2013 in Asthma and Allergy
Question: Severe Joint Pain, Rashes & Fatigue I'm an IT consultant who spends 10-12 hours with a laptop since last 6 years (No exercise). I quit smoking in Feb - 2013 suddenly (from 1 pack a day to zero). I gained weight (6-7 kg) & since then I started daily exercise (mostly aerobics & yoga) until I observed severe pain in my joints (especially knees & shoulders). I've 3 years of martial-arts/yoga background. Initially I thought it's normal as I just started exercising after 5 years and expected the pain to eventually go away. However, the pain continued and after few days I started getting itchy rashes (similar to hives) in my chest arms, thighs, belly. I started observing that I get these rashes more after bath or exercise (sweat). These rashes are more prominent in skin folds but I also got them in non-skin folds as-well. I've experimented by changing detergent/soap/hot & cold-water/food habit..nothing helped. I also started feeling extremely sleepy and lost motivation and concentration on work. My memory also got affected. My vision also got cloudy/blurred and I got a glass . I had to stop exercising as I felt extremely weak after exercising and severe joint pain. I've been taking a multivitamin and protein supplement everyday since last few years as I was thin and my daily food did not contain much vegetables. I went to doctors and got my blood test done. The only thing identified in the report is raised CRP level . The doctors prescribed jointace, collagen, vitamin d3, gabapentin & hifenacP for few days. I continued it but did not see much improvement. The doctors did not prescribe anything for the fatigue and rashes. I started digging symptoms online and read that it could be an autoimmune disorder. For rashes, initially I found that this might be due to abnormal histamine level/release and inflammation (confirmed by raised CRP level in my blood report). I tried both gen1/2 antihistamine (benadryl/cetrizine) but that made me even more drowsy so I did not continue them. I also found that the rashes look similar to hives & mold allergy. My house do not have proper ventilation and I also saw very little mold in few wet walls in my house. I confirmed with my other family members and they said they also got itchy rashes which goes away by it self in few minutes. This rashes are similar to mine but they do not get as much as I do. Which made me think it might be related to my immune system as I also got joint pain & fatigue. One other thing I noticed that if I scratch or apply pressure to my arm/knees I can see red patches/scratch mark which stays for a while. The fatigue increased and became so bad that I could not even show interest in basic tasks. I doubled my multivitamin capsule (revital/supractiv which contains Gensing) which helped a little but not much. I desperately searched online again and found modafinil ( used for narcolepsy). I read about the side effects & reactions and started with very low dose (10 mg) and gradually increased as I got none of the serious side effects. I'm aware that self-medication could be XXXXXXX but modafinil is the only thing which helped with the fatigue & motivation (My job demands focus and analytical thinking ), although I'm not taking it everyday. I'm good for few hours when I'm on it but the rashes & joint pain remains. I've started mild exercise again since last 30 days. The pain/rashes still do not go away. I feel tired after exercise and the joint pain increases. The fatigue/sleepiness comes back if I'm off modafinil. I don't want to develop a dependency/tolerance on any stimulant. I year back I was very active and focused and now this condition is driving me crazy. It is affecting my work and I'm seeking urgent expert guidance to diagnose and cure this as soon as possible. Currently I'm on the following medication: Multivitamin (1 cap) daily Collagen (10.2 g) daily JointAce (1 cap) daily Vitamin D3 - 1000iu daily Omega 3 fatty acid - 2 caps daily Modafinil 50mg - alternate days WheyProtien - alternate days Similar Rash Images: WWW.WWWW.WW WWW.WWWW.WW My questions: Looking at the symptoms, could it be autoimmune disorder ? Is quitting smoking related to this ? (i.e. Hyperthyroidism) Could it be related to arthritis ? (RA factor was normal in the report though ) I don't want pain killers or stimulants to suppress the symptoms. To find the root cause, where should I start ? Raised CRP level is an indication of inflammation. How do I find out what's causing it ? I did the blood test in May 2013. What further tests are required for proper diagnosis ?
doctor
Answered by Dr. Sujoy Khan 9 hours later
Brief Answer: Urticaria (need to exclude autoimmune disorder) Detailed Answer: Hello XXXXX, Welcome to Healthcare Magic and hope I will be able to point you in the right direction. Your symptoms (skin rashes) suggest a condition where histamine levels rise in response to stress, infections, occasionally drugs (like painkillers), abnormal hormone levels (especially thyroid) that is URTICARIA. Allergies are NOT the cause of urticaria, although you may have underlying allergies that may be detected in the testing process. ANSWERS to your questions - Looking at the symptoms, could it be autoimmune disorder ? Underlying autoimmunity needs to be excluded given the joint problems, ANA test that screen for underlying connective tissue diseases should be done first. Rheumatoid factor or Anti-CCP antibodies specifically excludes rheumatoid arthritis, although unlikely. Anti-thyroid antibodies (Anti-TPO, TG) needs t o be done at the same time as ANA. Vit B12, folate, iron levels will determine whether they need to be corrected. Vit D3 levels will be normal as you are now on treatment with 1000IU, was it checked before start of treatment? Is quitting smoking related to this ? (i.e. Hyperthyroidism) No, but thyroid disorder needs to be excluded. Anti-TPO, TG and TSH needs to be done. Could it be related to arthritis ? (RA factor was normal in the report though ) Excellent, as I alluded to earlier. C3 and C4 levels need to be done with ANA, to see if the arthritis is related to the rashes. I don't want pain killers or stimulants to suppress the symptoms. To find the root cause, where should I start ? As above. Raised CRP level is an indication of inflammation. How do I find out what's causing it ? Slightly raised CRP is common in untreated urticaria, so dont worry. Unless you have an underlying infection, such as urinary tract infection or tonsillitis. I did the blood test in May 2013. What further tests are required for proper diagnosis ? Hemogram Liver function tests Fasting glucose, lipid profile Uric acid ANA Anti-TPO Anti-TG C3 C4 levels Mast cell tryptase Vit B12, folate, ferritin (or iron) levels The treatment is usually high dose antihistamines for 4-6 months, skin lotion such as Dermocalm lotion. Immunosuppressants may be required if the C3 C4 levels or antibodies are strongly positive. Best Wishes.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Sujoy Khan 10 hours later
Hello Sujoy, Thanks for the detailed answer. I'll get all the tests tomorrow and get back to you with the reports. Based on the results we'll further discuss the possible treatment options. Thanks & Regards, XXXXX
doctor
Answered by Dr. Sujoy Khan 55 minutes later
Brief Answer: Yes, will review your reports and suggest a plan Detailed Answer: Definitely will review your reports and suggest a plan to keep things under control. You can start the combination of Fexofenadine 180mg 8-10AM and Montelukast-Levocetirizine 10/5 (9-10PM) and the skin lotions to control this until all results are available. Best Wishes.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Sujoy Khan 45 hours later
Hello Sujoy, I've uploaded the reports. Please find attached and suggest the next plan of action. The only one test missing is Mast cell tryptase, which will take more than a month as the sample has to be sent to the US and would cost around 8k. Please let me know if this test is still required. I've started Levocetirizine and Fexofenadine and will include Montelukast in a day or two.
doctor
Answered by Dr. Sujoy Khan 35 minutes later
Brief Answer: Unable to view reports - have notified webmaster Detailed Answer: Hello, I am unable to view the pdf files uploaded - maybe format error whilst uploading I have notified the webmaster Please continue on the Levocet and Fexo Mast cell tryptase at my Lab in Apollo Gleneagles Hospital Kolkata costs about 2k Results are ready in 3 days But we do not accept outside samples due to IT problems involved in billing etc Once I review the results, I can sort of make an assumption if tryptase will probably be normal. Best Wishes.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sujoy Khan 11 minutes later
Hey Sujoy, Please try this alternative download link for the reports (zipped): WWW.WWWW.WW Please let me know if it does not work.
doctor
Answered by Dr. Sujoy Khan 21 minutes later
Brief Answer: Results reviewed; no autoimmune cause identified Detailed Answer: Anti-CCP - negative, excludes rheumatoid arthitis as a cause of joint pains Hb MCV - normal, suggests iron B12 levels will be ok Vit B12 Iron Folic acid levels - fine Elements in blood - ok Eosinophil level - high (but with normal range) Glucose, HbA1c - normal, no diabetes C3 C4 - normal, suggests no complement consumption, hence unlikely urticarial vasculitis IgE level - normal ANA, Anti-thyroid abs - negative Total Cholesterol, TG - borderline elevated 25OH D3 - almost deficient I would add Aztor 10mg at bedtime to lower cholesterol if you already have a low fat diet; and Uprise D3 60k once weekly for 12 weeks. Repeat Vit D3 levels in 4 months, if levels still 'insufficient' restart Uprise D3 once-weekly for total duration of 1 year. Continue antihistamines for at least 3 months without an attack. Best Wishes.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Sujoy Khan 23 minutes later
Thanks much for the quick answer but I'm a little bit confused. So here are few quick questions to clear my doubts: Could you please summarize underlying root cause linking it to the symptoms ? What I currently understand is cholesterol level is high, vitamin D3 is level insufficient and rashes are because of ucitaria(hive) and abnormal histamine release. How can I control the fatigue and excessive sleepiness during day time? Should I continue modafinil/multivitamin or you have a better recommendation ? **This is really important as it is affecting my productivity and work performance. Should I continue exercise ? How should I control the joint pain & tiredness following it? Is it likely to reduce with the current medication or I need to take painkillers? **Exercise is making me worse, affecting my productivity. Should I continue jointAce (glucosamine chondroitin) and Collagen ? I'm already taking uprise d3 1k iu daily, so if I got it right, I need to stop that and make it 60K iu once in a week, correct ? Adding a missed question: I've also noticed increased production of thick nasal mucus causing trouble breathing sometimes. Could it be related ? (looking at the relatively high Eosinophil)
doctor
Answered by Dr. Sujoy Khan 34 minutes later
Brief Answer: Spontaneous urticaria; Vit D deficiency Detailed Answer: Hello, Answers to your questions: Could you please summarize underlying root cause linking it to the symptoms ? What I currently understand is cholesterol level is high, vitamin D3 is level insufficient and rashes are because of ucitaria(hive) and abnormal histamine release. Ans: There is no clear cut cause to your symptoms, although Vit D Deficiency is linked to worse allergies, recurrent influenza infections, fatigue, joint pains. You are having spontaneous urticaria, and no autoimmune cause as tests for autoimmunity are normal. It is quite good (in fact) as autoimmune urticaria can be quite difficult to control. How can I control the fatigue and excessive sleepiness during day time? Should I continue modafinil/multivitamin or you have a better recommendation ? **This is really important as it is affecting my productivity and work performance. Ans: You must consult your doctor about the continuous use of this medication. I do not have any experience with this. Should I continue exercise ? How should I control the joint pain & tiredness following it? Is it likely to reduce with the current medication or I need to take painkillers? **Exercise is making me worse, affecting my productivity. Ans: Best to change dose of Vit D Should I continue jointAce (glucosamine chondroitin) and Collagen ? Ans: No controlled clinical trials exist where efficacy has been proven. It has a good placebo effect, but what is does not do, is cause serious side effects, so can be continued. I'm already taking uprise d3 1k iu daily, so if I got it right, I need to stop that and make it 60K iu once in a week, correct ? YES The thick nasal mucous can be cleared with Nasoclear spray 2 per nostril three times daily. Best Wishes.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sujoy Khan 34 minutes later
Thanks again Sujoy. I'll follow your advice and update you on the improvements after few weeks. Closing the discussion for now. Thanks again for your time, really appreciate it.
doctor
Answered by Dr. Sujoy Khan 39 hours later
Brief Answer: Most welcome Detailed Answer: You are most welcome. Hope things improve soon. Best Wishes.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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