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Dr. Andrew Rynne

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What causes progressive pain in hands, legs and hip?

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Dr. Suresh Heijebu

General & Family Physician

Practicing since :2010

Answered : 3580 Questions

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Posted on Mon, 26 Oct 2015 in Pain Management
Question: Respected Sir/Mam,
My daughter is 16 years old and suffering from pain. 20 days ago, pain started in her one hand and then the other hand. Then within 5 days, pain started in her legs. 3 days ago she felt some pain in her hip. In starting, pain killer was prescribed but with no result.

Different tests were conducted but everything is normal. Only reactive protein is high 26 or like that. She is recently prescribed Cortimax 6 which I came to know as a corticosteroid. Also other medicines like one pain killer, one vitamin and one gas medicine. Should I go with the Cortimax? The doctor prescribed it for one month.

Please guide me what conditions she is suffering from and whether she should continue this steroid for one month or not?

Thanks in advance.

Regards,
XXXX
doctor
Answered by Dr. Suresh Heijebu 2 hours later
Brief Answer:
Possible Connective tissue disorder.Need Autoimmune panel.

Detailed Answer:
Hello, Sir.

I understand your concern.

I have gone through your query in detail.

Your daughter possibly has a migratory type of pain.

One should possibly suspect an underlying autoimmune /connective tissue disorder.

Please let me know if an Autoimmune panel is done for your daughter.If yes please let me know it's result.

At the moment, Cortimax seems to the appropriate drug at this moment since it has anti-inflammatory activity and quite rightly prescribed against autoimmune diseases.

Yes, it can be used for 1 month.

Post your further queries if any.
Thank you.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Suresh Heijebu 20 hours later
Hello Sir,

Thanks a lot for your valuable suggestion. I don't think any one has prescribed to do an autoimmune panel. I'm mentioning here all the test results for your kind reference.

BP - 112/68
HR - 110/min
ASO - negative
RF(Q) - negative
CRP - negative
sickle cell - negative
uric acid - 3.2
Hb - 10.7
ESR - 54
Anti Nuclear antibodies (ANA) - 0.27 (Tech. - TLISA)
Total Triiodothyronine (T3) - 107 (Tech -CLIA)
Total Thyroxine (T4) - 10.5 (Tech -CLIA)
Thyroid Stimulating hormone (TSH) - 2.65 (Tech -CLIA)
RBC count - 4.25
Hematocrit - 33.9
Mean corpuscular volume - 79.8
Mean corpuscular Hemoglobin - 25.2
Mean corpuscular Hemoglobin concentration - 31.6
Red Cell Distribution Width - 13.0
Platelet Count - 265
Mean Platelet Volume - 10.1
White blood Cell count - 10.7
Neutrophils - 72
Eosinophils - 04
Lymphocytes - 20
Monocytes - 04
Basophils - 00
C-Reactive Protein - 26.3
Blood Urea Nitrogen - 12

Echo Cardiography Report - everything normal

Presently prescribed medicines -

Cortimax 6
HCQS 200
Bonact
Rablet 20

Please guide what other tests should be done & whether the medicines prescribed are safe and effective or not. Thank you.

Regards,
XXXX
doctor
Answered by Dr. Suresh Heijebu 24 hours later
Brief Answer:
Anti CCP antibody testing will be helpful.

Detailed Answer:
Hello, Sir.

I understand your concern.

Your lab values reflect Mild anemia of chronic disease.
Negative ANA is a good sign.

Also, elevated CRP points towards ongoing inflammation.

Based on the symptoms, Rheumatoid arthritis needs to be ruled out.

For this, I advise you to get Anti CCP antibodies test.This will be every helpful.

If Anti CCP is positive additional drugs can be considered.

Currently, you are prescribed right medications.

Review with test reports.

Post your further queries if any.
Thank you.




Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Suresh Heijebu 9 days later
Hello Sir,
After continuing the medicine for 10 days, she is still suffering the pain. For 1 or 2 days, the pain was stopped to some extent but again it is the same. The pain typically is felt after rest and at late night during sleep.

We didn't have that test you refereed last time. Will that test be conclusive to reach at any particular point or need other tests? If so, please advise. Thanks

Regards,
doctor
Answered by Dr. Suresh Heijebu 2 hours later
Brief Answer:
This test will surely help.

Detailed Answer:
Hello, Sir.

I understand your concern.

Ongoing inflammation will lead to such fluctuations in pain severity.

It is very important that you get that test since it will help to narrow diagnostic possibilities.

Post your further queries if any.

Thank you.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Suresh Heijebu 12 days later
Hello Sir,

I'm really sorry for contacting you so late. But I'm at the same time really grateful to you for your guidance. As per your suggestion, we've done the ACCP. The results are;

ACCP - 0.53

25-OH Vitamin D - 9.85

So, basically it shows huge deficiency of Vit D. The doctors here referred D supplement. Even we stopped other medicines and continues only this Vitamin D & other vitamins. So far it seems that pain is reduced by 30 to 40%.

I've waited for 10 days to see whether taking this vitamin D would help or not. That's why I couldn't reply you back.

But I'm skeptical about one thing. My daughter is fond of non-veg food. She eats a lot of non-veg foods of all types. So, I don't think she should be deficient in D. Yes, she doesn't like to be exposed to sun rays. But still the level of Vit D sould not be so low.

Does it reflect other issues like her body can't absorb the Vit D or other problems. I think we should wait for at least one month to come to any conclusion.

But please suggest for any other guidance or tests etc. Whether we should continue the medicines ie, the pain killer, corticosteroid or not. We've stopped as she said the pain is not of that much and even she is not more complaining about pain in night. So, Please suggest accordingly.Thank you again for your guidance. Without your help we wouldn't have come to know about the deficiency.

Regards,
XXXX.
doctor
Answered by Dr. Suresh Heijebu 5 hours later
Brief Answer:
Get serum PTH levels and update me test results.

Detailed Answer:
Hello, Sir.

ACCP turned out negative.

Vitamin D deficiency can also largely contribute to muscle aches, bone and joint pains.

We need to wait for at least 6 weeks for the deficiency of Vit D to correct and improvement in symptoms.

Additionally I advise you to get serum PTH levels.

Often, patients with vitamin D insufficiency have a corresponding elevated PTH, indicating secondary hyperparathyroidism. Parathyroid hormone levels start to rise at 25(OH)D levels below 31 ng/mL which is another marker of vitamin D insufficiency.

An inverse relationship exists between PTH and 25(OH)D levels.Usually, PTH levels decrease after the correction of a vitamin D insufficiency.

The deficiency of Vitamin D in her case could be due to the side effects of steroids and other drugs used in pain management.These drugs can impair vitamin D absorption.Hence, I do not think it is a direct problem with absorption at this moment.

Therefore as of now, it is wise to stop the steroid and other analgesic medications.Continue to give her good food rich in vitamin D.

Please make sure vitamin D in her case is replenished as per following protocol

Recommended treatment for vitamin D–deficient patients 1–18 years of age is as follows-

2000 IU/day of vitamin D 2 or D 3 for at least 6 weeks
or
50,000 IU of vitamin D 2 once weekly for at least 6 weeks.

When the serum 25(OH)D level exceeds 30 ng/mL, provide maintenance treatment of 600-1000 IU/day.

Post your further queries if any.
Thank you



Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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