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    What causes joint pain, muscle pain and shifting pain in knee to ankles?

Posted on Fri, 3 Jun 2016 in Sexually Transmitted Diseases
Question: I had a protected sexual encounter with a CSW around 1.5years back, after that I developed uti, and fever then 1-2 weeks later had this reactive arthritis kind symptoms so I went to doctor , he tested me cbc (normal) CRP (7.5 ,normal range is 0-5), esr (slightly high) , uric acid (normal), rheumatoid factor(normal), vitamin D-25 (slightly low)
I had a clear urine routine test and urine culture and sensitivity test (they were normal don’t know whether they are suffice to rule out CHLAMYDIA and GONO and other STDs), doctor also tested me for hiv, hsv, vdrl, hepatitis etc which were negative. My vitamin D25 OH was slightly low. Doctor’s pre diagnosis was Reactive arthritis, he gave me 500mg azithromycin for 5 days and few more medicines for rising vitamin D level.
I took the medicines, felt like lost little muscle mass during that time Anyway I had that reactive arthritis kind of symptoms lasted for 1-2 months and slowly they went away , I was good for a year or so.
But after a period of almost 1.5 years suddenly I started feeling the same symptoms of reactive arthritis again which I had experienced a year earlier also I dint indulge in any kind of sexual activity since the last time (absolute no) . the symptoms were the same joint pain, muscle pain , pain shifting from knee to ankles sometime in elbows sometimes in fingers, I feel like I m loosing the muscle mass again near my joints
I went to see the doctor told him the total story, he tested me TPHA, blood work for cbc, CRP, esr, uric acid, rheumatoid factor, vitamin D-25, calcium serum, alkaline phosphate, ANA antibody, ANS-ds-antibody, HLA-B27, hiv) all of them were normal
Doctor prescribed me AUGMENTINE 625D, doxy for 1 week , I took the medicines as per the prescription but the symptoms are same, the reason I am worried is:
1)     could this be because of STD though I already tested for most of them but I read that it could be because of chlamydia or gono, I am not sure that the normal urine routine and culture my doctor ran at the first time rule outs this possibility.(I don’t have any urine related issue no discharge no burning nothing) I want to rule out these two possibilities which could be the probable reason of Reactive Arthritis second episode.
Please guide me which test I should go for, I am not sure that the urine PCR for chlamydia or gono will give a clear picture as I had the exposure more than a year back plus I don’t have any urine related issue as of now.

2)     What could be the probable cause of my symptoms (when most of my test came normal)

3)     If it is RA then How longer Reactive arthritis lasts , which doctor would be appropriate to go to.

thanks a ton in advance, please respond .
Answered by Dr. Saumya Mittal 10 hours later
Brief Answer:
Seronegative arthritis

Detailed Answer:
I am Dr Mittal.
I have read your message.
I think I can help you.
The symptoms of the query are quite suggestive of a possible seronegative arthritis.
I don't know whether you have met a rheumatology specialist.
That would be better to deal with your condition.
I don't think that it's because of the intercourse.
What is the ESR levels?
What is the CRP report?
I have tried to make it as simple as possible. I hope that the information contained in this message will be able to help you find the best solution for your problem. Best of luck. Dr Mittal.
Above answer was peer-reviewed by : Dr. Raju A.T
Follow up: Dr. Saumya Mittal 5 hours later
Thanks for the responding sir,
I had tested myself for ESR (NORMAL) crp (NORMAL) and other blood TEST NORMAL during the starting of the second episode of the RA symptoms (NOW A DAYA) but I believe that the arthritis kind of symptoms I m suffering has something to do with the encounter I had.
Anyway could u please please answer my point 1..

1) WHT could have triggered RA this time though I did not had any sexual activity since my last time

2) if there is a possibility that this could be triggered because of some STD bacteria I still have in my body..I m only suspecting Chlamydia or gono....please clear this doubt of mine...guide me which test I should go for (I don't have any issue in urine functions as of now , no discharge or burning) m very much concerned with the RA issues m suffering now. ..

3) thanks kindly any doctor who has treated the symptoms and problems like mine , please respond.
Answered by Dr. Saumya Mittal 5 hours later
Brief Answer:
Specific information

Detailed Answer:
Thanks for your response.
First , to clarify, I have treated gonorrhea and chlamydia. And this doesn't sound like the acute infection. besides , you already said pcr tests are negative.
Second , the arthritis develops because you develop antibodies to bacterial infection. For subsequent events you need not develop a infection again. Those same antibodies work against human tissue.
Try a simple course of etoricoxib.
That should help you.
Best of luck. Dr Mittal
Above answer was peer-reviewed by : Dr. Deepak
Follow up: Dr. Saumya Mittal 1 hour later
thanks a ton dr mittal sir for responding,

however following are few points i would like to outline:
it would be very appreciable if you address them point wise sir:

1) sir i would like to clarify that i had tested simple urine routine, and a routine culture and sensitivity after 18 days of exposure, which was normal and again after 2 months my GMP repeted these two tests which were normal again.(these were the only urine test i have done so far , do they rule out std testing for CHLAMYDIA and GONO? or i should be tested again ,pls tell the appropriate sir)

rest of the blood work test i have mentioned in my first question sir (please go through them sir once again sir, i m not that good in writing, specially in english)

2) sir the problem i am facing now d days is that i have joint pain and inflammation mainly in knees and inflation the pain shifts from knees and then ankles and sometime in fingers , elbows , wrist , i m even feeling that sometimes i have pain in my heels (shoe palm)
i even have wasted a muscle mass , i can clearly feel it in my elbows there is this itching kind of feeling always,
these symptoms are same as i experienced just after the exposure i had.
sir i dint indulge in the sexual activity since last 1.5 years

3 ) the doc i had visited 1.5 yrs back reached to a provisional diagnosis of REACTIVE ARTHRITIS,
i visited a GMP a week back just 2-3 days later when i started feeling the joint pain episode 2, i told him the complete test history he gave me AUGMETINE D625 and DOXY for 1 week, but it dint help , symptoms still same,
4) so i am afraid that is this the second episode of reactive arthritis?
5) how severe it can become?
6) what course of medicines i follow? (i m already on Neproxyn prescribed by ortho doc for join pain)
7) should i start having DOXYcicyline again .?

thanks a ton doc for your time , really appreciate please you answer these 7 points,

PS:i can plan an appointment once m back in XXXXXXX my mel address is sumit0000attherategmailcom

THANKS AGAIN SIR its MY chance of QUERIES.god bless you

Answered by Dr. Saumya Mittal 12 hours later
Brief Answer:
Specific information

Detailed Answer:
I have read your message.
Here are my responses.
I will try to make it comprehensive.
So it won't be point wise like u expected.
However I will cover all your points.

First you need to understand the condition. That's very important.
Arthralgia like what we are considering occurs due to a reaction to an infection. The body defends against the infection. The molecules against the bacteria are retained in the body for future use in case of possible reinfection. So I won't expect you to have a second infection specially considerING the absence of further sexual activity.
Taking it further the defensive molecules sometimes damage the body tissue because they get mistaken that the body tissue is infective organism. When the tissue involved is bones arthralgia results. This is called reactive arthritis. The trigger for recurrent arthralgia are minor like trauma etc and need not always be repeat infection. This arthritis if not categorized by a blood test is known as seronegative arthritis. It needs steroids and immunosuppresants that need a prescription from a rheumatology specialist.
As for the infection cultures ate the best test. So you can test a blood and urine culture tested. If it's still causing the problem of arthritis it would be detected. Else test a PCR test of gonorrhea and gene amplification test of chlamydia. Antibiotics like doxycycline should be taken if the test comes out positive. If adequately treated the first time it's not usually needed.
The common blood tests that should have been done in your case of arthralgia are
RA factor
ASO tiers
Uric acid
X ray of the hand
Synovial fluid culture.
I have tried to make it as simple as possible. I hope that the information contained in this message will be able to help you find the best solution for your problem. Best of luck. Dr Mittal
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Answered by
Dr. Saumya Mittal


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