Brief Answer:
arthritis

Detailed Answer:
Good evening XXXXXXX I have gone through your history . you have been having long standing gout. In long standing gout it can happen that the knee joints start getting affected. The involvement of shoulder is unlikely though.

As for rheumatoid arthritis , it does involve the hand and foot joints initially but the atypical variant is also known.

To distinguish between rheumatoid and gout one needs to evaluate certain things: pain is a very vague symptom, but your doctor needs to document swelling. If there is swelling the best investigation is to aspirate the fluid and check for any gout crystals. It is more sensitive than MRI and x ray

Secondly one needs to check for rheumatoid factor, anti CCP , ESR and crp. If they are elevated it can favour rheumatoid.

If you have a facility for muskuloskeltal ultrasound that would be more sensitive.

Do let me know your results and other queries. I would be happy to help

Hope the information was useful

Regards

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Brief Answer:
arthritis

Detailed Answer:
Oh no problem at all..do let me know..will help you out with whatever I can..

Regards

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Brief Answer:
arthritis

Detailed Answer:
Good evening XXXXXXX Well that is good so far that the ESR and crp are normal. I am expecting CCP to be negative as well. I did forget to ask you your age...

These symptoms do fit into a non inflammatory sort of arthritis called osteoarthritis. From what you describe it s an early stage and if you take proper precautions it can be controlled with exercise , a good posture and few medications. Pain on climbing stairs is one of the first signs of it.

Do let me know your age, height and weight. And your anti CCP results. I will let you know the precautions and exercises

Hope the information was useful

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Brief Answer:
arthritis

Detailed Answer:
Good evening XXXXXXX I understand your concerns. If you haven't consulted a rheumatologist you need to see one right now.

If your pain in shoulder is a lot kindly take a painkiller till you see your doctor again.

As for MRI you can get it done for your shoulder. If the pain is too Much we need to look into it for any ligament tear or for any evidence of arthritis. And get an x ray done for both your knees in standing position .MRI of knees won't be of much significance.

Don't suffer so much. Consult your doctor early. For the shoulder pain you have we normally inject a tiny dose of steroid aroind the joint capsule which relieves the inflammation and pain. Anti CCP antibody positive or negative should not change the acute management of your pain.

Do let me know for more queries

Take care

Regards

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Brief Answer:
Arthritis

Detailed Answer:
Good evening XXXXXXX

Firstly you dont have to be sorry or anything. I am here to help you out..

As for the kind of arthritis you have, it is very hard to predict it at this stage what sort of arthritis it is. Cause if the symptoms are progressing to involve your hands, neck, ankle then once needs to examine them to look for any inflammation. Early arthritis can be detected using Musculoskeltal Ultrasound which we run in our setting.

Yes you are right, osteoarthritis does not affect many joints. But initially u had said it s mostly the knees on exertion and right shoulder. So it wasnt fitting into Rheumatoid . But if the symptoms are progressing, one needs to look for any signs of synovitis before starting you on higher medications.

It s ok if you got MRI of the knee done, i had told you it would be osteoarthritis. I understand your apprehensions and i think it will be better if we could examine you and give you the exact diagnosis and management. Once a patient has a diagnosis, he does feel better.

Oh yes, you are most welcome to visit XXXXXXX We get lot of people from Middle east who come for treatment here. I am currently practicing in XXXXXXX in one of the prime hospitals here. ( Medanta, the Medcity). SO incase you are interested , do let me know. Can arrange things accordingly.

Regards

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Brief Answer:
seronegative rheumatoid arthritis

Detailed Answer:
Good evening. Yes there is a term called seronegative rheumatoid arthritis, which means that both rheumatoid factor and anti CCP are negative but patient still has arthritis. It has a better prognosis than the positive one.

Oh sure you can look up on information about the hospital on the net. If it satisfies you let me know. Can you forward me your corresponding email. I can ask the international desk people to get in touch with you and they can arrange the rest for you.

Regards

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Brief Answer:
arthritis

Detailed Answer:
Good evening XXXXXXX I have contacted the international desk people. They will get in touch with you and arrange for your visa,stay, pick up and drop and appointment. Incase you don't hear from them let me know..

Regards

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Brief Answer:
arthritis

Detailed Answer:
Good evening XXXXXXX Well I will be XXXXXXX with you. The x ray report does look suspicious of a sclerotic lesion, meaning some form of growth is happening. But without seeing the film it will be hard to comment exactly what it is. You got your MRI of the knee done as well right? MRI is more sensitive than x ray but it did not show any evidence of sclerosis. Do check up that report as well

Are you experiencing any symptoms of prostate enlargement like increased frequency of urine or hesitancy.

The pain you are experiencing in the knees doesn't look to be due to bone tumour. The bone tumour pains are present thoughtout the day and they will be more intense in the nights, so much so that it won't let you sleep. It is unlikely for a bone tumour to be present at both the sides at the same time

But yes if there is evidence of sclerosis on xrays it is better to get PSA done. But I would still like to see the film Nd the MRI. The best investigation for you is to get a triple phase bone scan or a pet ct done to rule it out. That would show the evidence of sclerotic lesions elsewhere as well. But don't panic, check your mri report and let me know.

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Brief Answer:
arthritis

Detailed Answer:
Dear XXXXXXX

I have gone through your MRI report. From what they have mentioned doesn't look any additional bone growth. They have mentioned about looking at the bones and it seems OK.

But just to solve the discrepancy between the two , it will be better to take a 2nd opinion while examining the film. So if your visit is planned you can bring the films along and we can consult a musculo-skeletal radiologist here. Dropbox may not work as the radiologist won't be able to see . hope you understand

But I don't think you should be worried too much here. It should get sorted out soon.

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Brief Answer:
Arthritis

Detailed Answer:
Oh XXXXXXX dont worry about the questions. We are here to help you out only

I have seen the x rays. But sorry to say, the films are not clear enough. Like lot of light is shining through it which is distorting the real image. Sorry about it, cant really comment on it. There are some changes which i could see, usually seen with osteoarthritis. These changes look like chondrocalcinosis. That is some form of gout changes.

But hey dont worry, if MRI is clear we are going good . You will be getting your CCP results tomorrow right. We ll just see those

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Brief Answer:
arthritis

Detailed Answer:
Good evening XXXXXXX .well that's good that he ruled out rheumatoid. It wasnt fitting into it.

I am not too convinced about fibromyalgia.it is more of a diagnosis of exclusion when everything else has been ruled out.

Don't worry about discrepancy. If you are planning a visit we will compare the two and give you a final diagnosis. I highly doubt it is sclerosis.

You just relax for now. And continue the management as advised. Stress does increase the pain.

Take care

Regards

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