Brief Answer:
Cause of arthritis

Detailed Answer:
Good evening

Thank you for writing on health care magic

I have gone through your history and the blood reports. There is something I would like to clarify here:

1. Was there any swelling in the knee joints when the pain started or during the course of your illness??

2. Was it associated with any early morning stiffness or pain in the nights?

3. ANy associated backache , neck pains, heel pains or chest pains??

The diagnosis of arthritis does depend on the swelling along with tenderness of the joints as all your tests results are normal. So, before I comment further I want to be sure it has been diagnosed currently.

As for the advise on your query,

1. The diagnosis I can comment a bit later. Yes, Examination of the knees will give me a better view to comment on it exactly.

2. As for your medicines, I am not sure what is the role of Zycolchine here. You dont have gout symptoms as it does not last that long. So I would suggest you can hold that. Secondly, Saaz is not such a good drug for arthritis involving the joints apart from the knees. If it is really Arthritis, Methotrexate will do better

3. Seronegative arthritis is not curable but controllable. With medications, it tends to get better and you will get back to your normal routine again. But yes, the medication dosage needs to be optimized according to your situation and the response to treatment. But once under control, you can carry on your activities just like anyone else.

To conclude, I still want to be sure about your diagnosis first before I can really comment on further advise. ALso do let me know your exact location and the Rheumatologist you saw. Incase needed for a second opinion, I can guide you for it

Regards
Dr Naval

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Brief Answer:
Seronegative arthritis

Detailed Answer:
Good evening

Sorry for the delayed reply. Was caught up at work.

Well, it is very hard to label it as arthritis especially with no swelling of the joints, normal inflammatory markers( ESR, CRP) and negative tests for arthritis( ANA, HLA b 27, RF, Anti CCP). One has to be more sure before labelling it as seronegative arthritis as it least one of them should come out positive.

Secondly, the pain you are describing is more on activity than at rest. That goes against the inflammatory arthritis as well as most of the inflammatory arthritis cause pain and stiffness after rest and get better with exercise.

SO, to come to the exact diagnosis I would suggest a thorough clinical examination once again, Do check your Vitamin D Levels as well and if needed maybe an MRI of the knees to see what exactly is causing pain( considering there is no swelling).

In XXXXXXX you can consult Dr Bose( not sure about the full name). He practises at the medical college there. Just to have another opinion, cause even if it is seronegative arthritis, then it s better you switch to Methotrexate along with a short course of steroids to control the inflammation. Also I would like you to try some antiinflammatory drug meanwhile( Tablet Nucoxia 90 mg once a day at night for 5 days).

Do let me know for more queries. Would be happy to help out

Regards
Dr Naval

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Brief Answer:
Cause of arthritis

Detailed Answer:
GOod evening

1. Well, the sort of history you are giving, it fits in more with Osteoarthritis than the seronegative inflammatory arthritis. Although, your age is quite less for this disease, but the symptoms you are describing fit in more with Degenerative variant. Secondly your blood reports do not show anything alarming either. Mild Raised CRP( ASO holds no significance at your age) doesnt guide us anywhere. For inflammatory arthritis, the levels would go up to 30-25.

2. But yes, do supplement yourself with Vitamin D Supplements. 17 is quite low, the normal universal cut offs are 35( I am not sure why the lab has mentioned 20). You can start capsule Uprise D 3 60 k once a week for 12 weeks and then once a month to continue.

3. If you have done a X ray of the knees, kindly attach that. Would like to see the state of the knee at present.

4. It is not a nerve problem. Neuropathy normally does not manifest this way. The other possibility was Muscle weakness since the way you are describing. But your CPK levels were within normal limits. That is one thing I would like you to repeat again.

5. As for my opinion, all said and done Examination is the key here. Firstly we need to see if it is the joint which is being affected or the muscles( thigh muscles). There doesnt look like any other cause here.
From the symptoms and the lab reports, it does not look like inflammatory arthritis to me. So, either the cartilage is getting deprived or there is some ligament injury. But yes, if on examination there is obvious swelling and tenderness, then we can go in favour of inflammatory arthritis. Or else, we need to think of some other cause.
Secondly, even your muscle examination needs to be carried out thoroughly once. These are the symptoms which a person experiences when there is muscle weakness or inflammation. So, rather than just examine the joints this is one thing we shouldnt ignore.

I would suggest you take a 2nd opinion and let the doctor examine with an independent view. My Differential would be Osteoarthritis( Early) with Vitamin D Defiency vs Myopathy...

Hope the information was useful

Do let me know for more queries

Regards
Dr Naval

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Brief Answer:
Avascular Necrosis

Detailed Answer:
Good evening XXXX

As suspected, there is some other problem we are dealing with. Since the symptoms you were describing, with more difficulty in getting up didnt look like seronegative arthritis. But yes, I am bit surprised to see the MRI report. Avascular necrosis doesnt sound good and the report says that the bone head has collapsed. The big question is, why it happened??

Did you take any natural treatment or steroids for your pains by any chance??

We need to investigate the cause for it , so we can halt it from happening at other places.

Pertaining to your queries:

1. Firstly the symptoms are more on weight bearing. So, you will have difficulty in getting up and walking. Try using a walking stick so, it puts less of pressure on the hip joint. Also, you need to start some Bisphonates( Alendronate/Risendronate) to help stop the bones from collapsing further

2 The problem as per MRI is quite severe, as the hip joints are unable to take your weight. I am a bit surprised, as it has happened at your age.

3. Well, curable I wont say. But at present you will need a bit of surgical intervention for the collapsed head. More over we should rule out why it happened....Both the aspects need to be looked into. The most common causes of avascular necrosis are: Medications like steroids(2) Injury to the area ( 3) Any clotting problems.( 4) Obesity. All these need to be addressed simultaneoulsy so we know where exactly we are going wrong.

It is not seronegative arthritis as i had said. Did you go for a 2nd Opinion??

Do let me know for more queries

Regards
Dr Naval

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Brief Answer:
Avascular NEcrosis of Hip

Detailed Answer:
Good eveningXXXX

1. Well, the symptoms of avascular necrosis are mostly pain in the hips and thigh region on weight bearing, that is walking. It is not present at rest but yes the movements are restricted on examination. IT need not be localized at the hip, but mostly radiates to the thighs and the knees( It can be distinguished from Examination only). Smoking is a definite risk factor for this problem and the most common sites are femoral heads. So that can be one cause as well

2. As for the blood clotting, there are a few autoimmune tests like Lupus anticoagulant, Anticardiolipin antibody which needs to be looked into to figure out the cause of clotting.

3. No, the medicines he gave wont cause such side effects. It probably had happened before you approached him. Just that the diagnosis wasnt localized properly which he eventually did as you were not getting any benefit.

4. As for the MRI analysis, it may not be wrong reporting. But you can always get it retested and I would suggest you do that and also get the CD compared. SO, 2 radiologist can give us a view on if it is AVN or not.

5. Lastly, I understand hip replacement does sound quite extreme. I still wont recommend you that. There is another condition called Transient Migratory OSteoporosis which is a very close D/D of AVN. That is one possibility you should discuss with the radiologist and only an experienced one can point out. It is a self limiting condition which goes off in 6-8 months. Since you dont have previous risk factors, this can be a possibility too.

Coming to the treatment options, Stem cells are also a good option for AVN. But lets discuss those at the end till we figure out the cause.

Hope the information is useful

Do let me know for more queries

REgards
Dr Naval

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