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Dr. Andrew Rynne

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Suggest treatment for seronegative rheumatoid arthritis

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Dr. Rishu Saxena

Cardiologist

Practicing since :2012

Answered : 696 Questions

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Posted on Wed, 8 Mar 2017 in Hypertension and Heart Disease
Question: I am a 34 yrs old female. I've had some issues since adolescents have included me having knee surgery on both knees to get them to stop dislocation. I was a long distance runner in high school. I was very flexible and clumsy. Mom called it being doubled jointed, runs in the family. So fast forward to the end of my 2 childs pregnancy. I had rupture of membranes at 36 weeks. Had a healthy happy baby boy with no complications except he was 6 lbs. He did leave the hospital with me. Two weeks later I developed mono and never really recovered from it. Still had muscle aches and pains. Several times a year through all this is strained ankels and writs with out doing much of anything to it. I got a probably fibromyalgia diagnosis. Never really got better, extremely fatigue constant feeling like I must sleep now...I got pregnant with my third child and delivered her in 2010. Prerupture of membranes at 34 weeks. She spent 11 days in nicu. She didn't have major issues just maintaining body temperature and jaundice. I felt great thru my whole pregnancy with her. Some muscle aches her and there. She was breast fed. In 2012 she stopped nursing as much and I started getting more pain when she fully weaned at age 3, 2013 I was diagnosed with seronegative rheumatoid arthritis. I tried many meds, I am taking plaquinel and humira. And it helps the pain well mostly. I still have pain around the joints in my elbows and ankles. I sprained my wrist opening a bottle of juice for my kids. I've rolled my ankle idk how many times. The ra pain is better. I'm still fatigued. Noticed I was getting a racing heart when standing. Been working with a regular cardiologist. Did a 2 week heart study and an echocardiogram. I have severe orthostatic hypotension and get very tachycardic. Ex. Sitting bp 110/70 hr 75 standing immediately bp 80/45 hr 187. I have begun pushing salt and fluids, my bp doesn't drop as much most days. On a good day when standing my bp only goes down to 100/85 hr 168. I've been referred to another cardiologist who is a electrophysiologist. I'm sure I will end up with a pots diagnosis or possibly an autoimmune related dysautonomia. But my hypermobility has me concerned, my rheumatologist said they don't handle that talk to cardio...so I am unsure where to go from here. A majority of the time I need to use a wheel chair to get around the house and all the time outside of my home because I cannot stand longer than 3 mins with loss of consciencNess. I can not drive safely. I also experience headaches with the bp drops. Or just sitting upright too long. I scored myself on the hypermobility test and got 7/9 I am pretty sure my knees would hyper extend if they hadn't been operated on. Does anyone have some suggestions on what doctors I need to see to get the care I need?
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Answered by Dr. Rishu Saxena 48 minutes later
Brief Answer:
Various specialities should discuss the case together.

Detailed Answer:
Hi
Firstly i am sorry for your condition.
I have gone through your history in detail.

My XXXXXXX opinion is that you should go for genetic testing ,Most likely all these problems are interlinked to each other;Possibly it can be a genetic disorder which is causing autoimmune changes involving different organs(from bone to rheumatoid to dysautonomia).
A very detailed investigation would be required to rule out the cause of these changes,as unless we know the cause we can't treat it.
As per your question,
I would suggest you to consult a Rheumatolgist ,Medical genetics specialist,cardiologist,vascular surgeon and endocinologist and request them to discuss the case and possibilities together. Many specialities have to discuss this case to come to a conclusion, and you have to follow what ever they advice.There should be a coordination between all the doctors treating you.I would advice you to move to a quaternary hospital,instead of consulting each speciality seperately.

I hope you can understand the gravity and intensity of problem , so conclusions and suggestions can't be given without detailed investigations.Once we find the cause we can stop it!

Thank you and Good luck.
Above answer was peer-reviewed by : Dr. Yogesh D
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