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Suggest Treatment For Left Hand Joint Pain And Inflammation

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Posted on Mon, 7 Sep 2015
Question: I don't know if anyone can help me as I seem to have baffled health care professionals so far. I have a pmh of non specific colitis of the terminal illium, pylonephritis, reaccurent uti, pleurisy, reaccurent tonsillitis, night sweats, vit d deficiency, folate deficiency, b12 deficiency and fatigue. I have a family history of rheumatoid arthritis and psoriatic arthritis. Tonight my left hand was red and inflammed at the joints followed by it swelling up and it hurts. Does anyone have an idea what's going off with me I know there's something not right with all if this has happened over the last 4 years
doctor
Answered by Dr. Naval Mendiratta (7 hours later)
Brief Answer:
Multiple Issues

Detailed Answer:
Good evening

Thank you for writing on health care magic

Well, you seem to have a lot of problems going on and there is a chance that all of them are related than different problems going on.

I would like to ask you a few more details before guiding you further:

1. When did you have Pleurisy episode? Was it one sided or both sided??Did it subside with medications or itself?

2. Did you have any arthritis before this episode or is it the first one?? If you could attach a picture of the joint it would be helpful.

3. Any history of oral ulcers/Hair fall/Rashes over the face and limbs??

4. How bad it the colitis right now??Is it well controlled or does it still flare?

5. Any history of dry eyes or dry mouth

6. Did they perform any blood tests for you recently? I understand in UK they do tests in a very limited way, not till the time they are sure and it does delay the diagnosis, more than that it hampers the patient as they dont get the diagnosis

Do let me know these queries

Would guide you further from here

Regards
Dr Naval


Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Naval Mendiratta (1 hour later)
Hi thank you for your response, I was discharged from rheumatology in february they redid all the ana tests which came back negative at that point as one was around the 100 mark in august of last but the rheumatologist said 10% of the nation could have it in that range and it not be a problem but he had diagnosed lupus with someone with those markers before but he didnt think it was lupus as I wasn't presenting like a normal lupus patient, my inflammatory markers have never really been elevated either apart from when i had quite a nasty anal fissure in december of last year which healed by itself. I had pluerisy in may of this year which resulted in a hospital admission only on the left, and was treated with pain relief only but I have had the pain back since but has resolved at the moment. The colitis was found last XXXXXXX was treated with budesnide 9mg then reducing dose and since i have seen a different consultant who thought it was ibs but wants me to see my usual consultant as my bowel habits still go from one extreme to the other. My rheumatologist also thought there could be enterpathic arthritis related to the colitis but has since ruled that out. I do get a lot of dry mouth and ulcers and i permanently have a sore throat which the gastro consultant told me to drink more fluids and eat more fruit but trying that i got an ulcer on my throat that turned septic, then my lips and gums swelled up and then i got tonsilitis this was a month ago and they intermittently swell up and have since got tonsilitis again. My menstrual cycle has also become less regular; which my gp thinks is hormonal as I havnt had a period in two month and I have the copper coil. I did upload a picture of my hand yesterday onto my profile I'm not sure if you can see it?
Thank you XXXXXXX XXXX
doctor
Answered by Dr. Naval Mendiratta (10 hours later)
Brief Answer:
Is it autoimmune

Detailed Answer:
Good evening

Thanks for your reply

Well, I have seen your results but could not find the autoimmune markers in it. But as you have said they were negative to start with.

The rashes over the knuckles look more of an allergic/ urticaria one but we need to observe it to look if they increase or disappear with time.

But yes considering the episodes of pleurisy, oral ulcers we need to look into some other autoimmune causes as well, like Bechets Disease. Also all the joint pains rashes and oral ulcers can be a part of Inflammatory Bowel Disease. I am not sure if colonoscopy and Biopsy were performed to give us the exact picture of what is going on. If it was done, do let me know the results

With ANA negative, lot of rheumatologist find it hard to label it as Lupus. The other way round is to repeat the test as advised after 3 months.

On a fair note, I still wont label you as Lupus as once labelled you will need long term and heavier medicines for yourself. I would like to observe you over time to see for the developement of new symptoms. Meanwhile do get HLA B 51 done for Bechets as well

I hope the information was useful

DO let me know for more queries

Regards
Dr Naval
Above answer was peer-reviewed by : Dr. Neel Kudchadkar
doctor
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Follow up: Dr. Naval Mendiratta (58 minutes later)
thank you, they did do a colonoscopy last year which is when they found the non specific inflammation in my terminal illium but no other tests were conclusive after that apart from my ct picking up a fatty liver. I've seen my gp today whose done a set of bloods fbc, esr, crp, u&e, lft, tft, vit d, bone profile and anti ccp I will let you know the results, thank you for your advice i'm very fed up at the moment as I feel like I'm going round in circles I will let you know my results.
doctor
Answered by Dr. Naval Mendiratta (21 hours later)
Brief Answer:
REsults

Detailed Answer:
Good evening

Sorry for the late reply. Was caught up in a long day shift

Well, that s good that they have run your tests again.

yeah, do let me know the results. Will like to see if we can interpret anything from it

Dont worry, it will get sorted out for you

Regards
Dr Naval
Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Follow up: Dr. Naval Mendiratta (40 hours later)
well my gp prescribed me etorixoib 60mg thinking it wouldn't upset my system for the pain in my hands and ive started with my gastric symptoms this morning do you think its the analgesia or a flare up?
and my tongue has become inflamed in the last 5 days see images
doctor
Answered by Dr. Naval Mendiratta (5 hours later)
Brief Answer:
? Drug reaction

Detailed Answer:
Good evening

Well, your tongue is quite red and swollen up. Have you tried this medicine before?? Did the tongue swelling happen after taking the drug or before it??

What sort of gastric symptoms are you experiencing? Is it acidity or loose stools?
If it is an acidity it is more of a side effect but if it is loose stools, then there is a chance it is affecting your ulcers in the intestine. We normally tend to avoid all strong pain killers when a patient has ulcers proven on Biopsy

Dont take any more etoricoxib for now. Consider starting on Tylenol for pain along with Anti histaminics like allergra for the toungue swelling to go . It shouldnt swell up any further

Do let me know these queries

REgards
Dr Naval
Above answer was peer-reviewed by : Dr. Neel Kudchadkar
doctor
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Follow up: Dr. Naval Mendiratta (49 minutes later)
the tongue started on wednesday before the meds, its loose stools theyve settled down for now but i'm gona go see gp tomorrow thank you
doctor
Answered by Dr. Naval Mendiratta (1 hour later)
Brief Answer:
Allergic Process

Detailed Answer:
Good evening

Well, it is definitely not a normal tongue, looks more of strawberry tongue. Ask your GP if it could be a sign of Vasculitis since you are already having so many problems elsewhere as well

Secondly, I wont suggest you continue with NSAIDS, it is probably harming your stomach ulcers causing increased loose stools. If any pain, Tylenol would be a better option

Do let me know what he says

REgards
Dr Naval
Above answer was peer-reviewed by : Dr. Neel Kudchadkar
doctor
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Follow up: Dr. Naval Mendiratta (13 hours later)
gp thinks its a bug all bloods were in normal range apart from anti ccp which hasn't come back yet, I just dont think it's a bug just my gut feeling I am also a nurse by the way
ive also just had quite a few ectopic beats in the space of half an hour should I be concerned I have been seen by cardiology and discharged with superventicular ectopics.
doctor
Answered by Dr. Naval Mendiratta (8 hours later)
Brief Answer:
Ectopics

Detailed Answer:
Good evening

Well, firstly I really dont know which bug will go bite you on your tongue and cause such swelling and color change. It is very unusual for something like that to happen.I feel somewhere something is being missed which need s to be looked into. See if your XXXXXXX has been performed yet as STrawberry tounge is very particular with this antibody

Well, for now keep a watch on your pulse rate. Maybe take an anxiolytic prior to sleeping. Incase you feel the palpitations are high, get an ECG done to be sure it is nothing something which is persisting. Guess you will be in hospital at the moment , so getting an ECG would be ok, just to be on safer side

Do let me know for more queries

REgards
Dr Naval
Note: For further information on diet changes to reduce allergy symptoms or to boost your immunity, Ask here.

Above answer was peer-reviewed by : Dr. Neel Kudchadkar
doctor
Answered by
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Dr. Naval Mendiratta

Rheumatologist

Practicing since :2007

Answered : 754 Questions

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Suggest Treatment For Left Hand Joint Pain And Inflammation

Brief Answer: Multiple Issues Detailed Answer: Good evening Thank you for writing on health care magic Well, you seem to have a lot of problems going on and there is a chance that all of them are related than different problems going on. I would like to ask you a few more details before guiding you further: 1. When did you have Pleurisy episode? Was it one sided or both sided??Did it subside with medications or itself? 2. Did you have any arthritis before this episode or is it the first one?? If you could attach a picture of the joint it would be helpful. 3. Any history of oral ulcers/Hair fall/Rashes over the face and limbs?? 4. How bad it the colitis right now??Is it well controlled or does it still flare? 5. Any history of dry eyes or dry mouth 6. Did they perform any blood tests for you recently? I understand in UK they do tests in a very limited way, not till the time they are sure and it does delay the diagnosis, more than that it hampers the patient as they dont get the diagnosis Do let me know these queries Would guide you further from here Regards Dr Naval