Question: Hello, I am a 25 y/o female. I have had L knee pain & supra patellar joint effusion since I was 15 years old. 2 years ago, I became pregnant and for the first time, my symptoms disappeared. They were gone until I weaned my son at 12mos. My L knee pain and swelling started again, and I began to experience pain in my R hand that was diagnosed as cubital tunnel syndrome. I had nerve conduction studies that indicated that the nerve was mildly entrapped at the elbow, so I had surgery in november 2014--release of the ulnar nerve at the elbow--which was ultimately unsuccessful. My pain began to spread to other joints, it seemed like every month I have a new problem. Now, in the last month or so, I feel as though a new symptom develops every week. I currently experience pain in the following areas: L&R wrists, L&R fingers, L&R knees, L shoulder/upper arm, L&R bottoms of feet.

On a scale of 1-10, in the mornings my pain is a 7, throughout the day a 5, and at night a 9. Some nights I am pretty much at the point of passing out at night because of the pain. I also have an extremely low energy level. I can sleep 10 hours at night and still be exhausted. I am also mentally exhausted from being in pain all day and I often feel depressed because I am tired of being in pain and I am unable to do things that I was able to do before. Some days, I don't feel comfortable taking my son out of the house because I can't pick him up very well. I am a full-time grad student (speech-language pathology), and I have had a terrible time keeping up with my work this semester due to my declining health.

I have had an x-ray and MRI of my left knee. I had blood tests and knee arthrocentesis.

The arthrocentesis showed the following clinical abnormalities: Protein Total: 4.8 HI, WBC Count, fluid: 2133 HI.

The blood test showed the following clinical abnormalities: CO2: 18 LO, LDL Cholesterol: 100 HI, ESR (Sed-rate): 39 HI, Creatine .44 LO, sCRP: 27.9 HI.

The x-ray reports the following: mild narrowing of the medial and lateral compartments of the knee for the pt's age. There is evidence of a prominent effusion of the supra patellar bursa. There is some haziness of the infra patellar fat.

The MRI did not show any muscular/tendon involvement and summarized the same effusion.

I have tried the following medications: celebrex, oral steroids, and ibuprofen 800. I did not notice any improvement on celebrex, mild improvement with ibuprofen, and almost complete remission of my symptoms for only the first 2 (out of 7) days that I was on steroids (tapering dosage)

Family history includes: cancer, heart disease, psoriasis.

I have been referred to a rheumatologist, although my RA factor is negative. My appointment is in two months, and I don't know how I'm going to make it. I am in tears every night because of the stress and the pain. Furthermore, I will be coming off of my father's insurance in 3 months and I don't know how I will receive treatment or what I will do if I can't get a diagnosis in 3 months time.

My questions are:
1. What do you think is/are the likely cause/s of my symptoms?
2. What are the treatments for these conditions?
3. Is it necessary to get a specific diagnosis for my condition, or are there certain medicines that treat many rheumatoid conditions that I could try to relieve my symptoms?
4. Are there any supplements, dietary changes, or exercises I can try?
5. What are my options for pain management at this moment? My PCP seems reluctant to prescribe anything other than ibuprofen 800, but I am truly at the point of hating my life due to the amount of pain that I'm in--and I was a very joyful person.

Thank you for your quick and very informative response. I am going to start with the diet modifications and other advice immediately. I have a couple questions regarding your response.

I am not currently taking steroids, although I have taken them in the past (a 7-day pack with tapering dosages) and found that they helped TREMENDOUSLY. I was under the impression (from my PCP) that steroids are not prescribed as a long-term option. Can you tell me if this is correct or incorrect?

Also, I understand that you have described my condition as polyarthralgia, secondary to a currently unknown etiology (RA, SLE, etc.). My question is--is it important to pinpoint the exact diagnosis?

You also stated that disease-modifying drugs can help. Are those specific to the diagnosis? Is that a potential reason to try to find out the etiology of my polyarthralgia?

Finally, how would you go about providing a diagnosis of one of these conditions? What are the diagnostic tools/procedures that are used?

Thank you again for your time.
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