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What causes joint swelling, pain in wrists, fingers, elbows, stiff neck , spine pain and memory loss inspite of having high ASO titres

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Internal Medicine Specialist
Practicing since : 2009
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Hello, I have been sick since last July with joint swelling, pain in my wrists, fingers, elbows, stiff neck and spine pain (spine feels bruised). I have short term memory loss (brain fog), vision loss, tightness/pressure in my chest and fatigue. I have been tested for a number of things and all came back negative so my primary told me I had mayofacial pain syndrome and wanted me to take cymbalta but I declined. Another doctor thought I had lyme even though tests were neg. Last week I again had a horrible stiff neck and saw the doctor. They did a western blot, ankylos. spondolitis, and anti streptolysin o antibodies. All came back normal except the aso was at 822. I have not had a sore throat... only enlarged red blood cells, vit. d deficiency and dysmotility of the espophagus. But now my doc said I need an ultra sound of my heart and put me on 875 mg of ammoxicillin twice a day for a week. My question is, what does the test result actually mean and my husband now has a sore throat. He had a rapid strep test and it came back neg. Is what I have contagious? My docs have left me in the dark and my husband seems to think he's caught my strep bacteria? I own a dance studio and have 3 children so i do not want to infect anyone! I have been in so much pain for 8 months and dont wish this on anyone! Thank you!
Posted Sat, 15 Mar 2014 in Infections
Answered by Dr. Anshul Varshney 18 hours later
Brief Answer: Strept Infection is a possibility Detailed Answer: Dear Friend. Hi , I am Dr Anshul Varshney , I have read your query in detail , I understand your concern. The increase in ASO Titres indicates an exposure to Strept. However, as many people are exposed to these bacteria and remain asymptomatic, the mere presence of ASO does not indicate disease. In fact , it can be raised due to some sub clinical infection in the past. This titre has a significance only if : 1. Highly Elevated (>200) 2. If if a rise in titre can be demonstrated in paired blood samples taken days apart. I would like to know following things : 1. Any history of fever in the recent past? 2. Any past history of Tuberculosis or Liver disease? 3. Any history of Alcohol consumption. False positives rise in ASO Titres can result from liver disease and tuberculosis. I don't think there is any problem in giving him a course of antibiotic. Now, if we talk about your scenario , a prophylactic treatment is usually indicated in contacts of the patient under following circumstances : 1. Individuals with history of rheumatic fever 2. Individuals who develop acute pharyngitis during an outbreak of acute rheumatic fever or acute poststreptococcal glomerulonephritis. 3. Spread of among several family members. In case you qualify any of the above , or you are having any symptoms of Strept infection you should take prophylactic antibiotic treatment. This is my personal opinion based on details available here. If you still have any query you may please ask me. Stay Healthy. Dr Anshul Varshney , MD
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Follow-up: What causes joint swelling, pain in wrists, fingers, elbows, stiff neck , spine pain and memory loss inspite of having high ASO titres 44 minutes later
1. Any history of fever in the recent past? -Just low grade 99-100.3 off and on since last July when my joint, back and neck pain started. 2. Any past history of Tuberculosis or Liver disease? -Not that I know of. 3. Any history of Alcohol consumption. -A glass of wine at dinner once and a while. I have been tested for all kinds of tick borne, mri, emg, rf, b19 and all have come back neg except my ANA was positive. Since last July I have had problems with my spine feeling bruised, joint pain that jumps around, swelling, stiff neck, loss/blurred vision, memory issues/brain fog and a sudden onset of early macular degeneration. I was told that last week my western blot and anklyosing spondolitis were neg. but that my Streptolysin O ab test came back at 822 when it shouldn't be hire than 220 and it may be the reason I've been sick for 8 months. They didn't tell me if it meant I had rheumatic fever or anything else. I don't really understand if the test result means I'm contagious even if I haven't had a sore throat or strep in I'm not sure how long, or if it even determines if I'm sick with something. Could you tell me what the result means?
Answered by Dr. Anshul Varshney 23 minutes later
Brief Answer: Rheumatic fever is a possibility. Also Vasculitis Detailed Answer: Welcome Again. I told you that a positive ASO titre means a recent or past infection with Strep. You have joint pains that jumps around (we call it migratory polyarthritis) , that can be a symptom of Rheumatic Fever. Yes , your doctor is right , you should get a Echocardiography of the heart to see for any evidence of Rheumatic Heart Disease. Your ANA is positive , then we should do work up to rule out Vasculitis Syndromes. Esophageal Dysmotility problems are frequently seen in Systemic Sclerosis. I suppose your doctor must have ruled out that. Joint Pains , Eye involvement , ANA positivity - With these three things we suspect Vasculitis Syndromes. I would advise you to get a complete work up done once to be sure of the diagnosis , so that once it is made , you can be treated accordingly , and your problems can be resolved. Following is the complete work up list (Omit the investigations that you have got already) : 1. Hemogram with ESR 2. C-Reactive Protein 3. Kidney Function Test 4. Liver Function Test 5. Chest Xray 6. Auto antibody Panel (including XXXXXXX , HLA B26) 7. Echocardiography I know it is a long panel of test , but a perfect diagnosis is required to help you reduce your sufferings. Discuss with your doctor about my opinion. Now regarding Strept infection , it can range from asymptomatic to symptomatic infection. With High ASO Titres , you should take antibiotics as have been advised to you. You can be contagious , but when you have been started on antibiotics , the infection would get treated with in 5 days. Usually , most doctors give a course for 5-10 days. No need as such to give antibiotics to your family for prophylaxis. If any one shows symptoms , he/she should be tested and treated. I understand you are suffering a lot due to your illness , but i am sure , with these investigations , a conclusion can be drawn about the diagnosis. This is my best advise for you based on details available. If you have any further query , please feel free to ask me.
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