What is the treatment for swollen painful ankle inspite of using steriods and painkillers?
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Hi, I am a 39 years old man , 2 months back i had a fever and after one week, i had pain in my ankle... I did my regular gym for 2 days and on third day, my pain increased, i shown to ortho doc, he said that this is because of viral fever.. he did xray.. report was fine .. he suggested me steroid and pain killer. i have not taken and just had pain killer, bit with time, the pain and swelling increase. again i shown to doctor he said it could because of injection ,.. so he given me antibiotic.. it worked, my pain and swelling got reduced .. the moment my course of 5 days antibiotic completed .. after 2 days again my pain and selling increased ... I then shown to another ortho doc... he said its recative synovitis .. he given me steriod injection two times in 15 days and anti inflammatory tablet for 10 days along with ciplox antibiotic ... in total period of 3 weeks, my condition improves and approx 95% it recovered.,only very light pain was there when i put my full weight on my foot. .. i again shown to doc and asked about this pain... he said it will go by time .. you start walking.. the next day i walked for 15 minutes with full weight and my condition got worst next day... there was a pain and swelling in ankle.. then i shown to my previous doc and explained the same details.. he got Ct scan -- report there is no infection either RA symptoms... even he got RA factor check and HB AI 47 PCR -- both were negative, uric acid : 4. 5 ... he said it could be because of fever only .. since there is no infection.. and pain and swelling is there and also that area is red and slightly warm ... so we have to start for arthritis treatment only .. steroid injection -- depomedrol 80 mg .and hdyroxychroroquine sulfate tablet.. sulfasa;azine delayed release tablet and folite and folitrax one a week one tablet...I just want to confirm that i am a patient of RA or its injection earlier and then it got injured because of extreme pressure that i put on my ankle for 15 days.... also if it is plain synovitis then what should be my approach and do i need to take rest for 3-4 weeks then only it will recover. kindly reply
Posted Sat, 22 Mar 2014 in General Health
Answered by Dr. T Chandrakant 1 hour later
Brief Answer: MRI and biopsy of the synovium , strict rest. Detailed Answer: Hi, Thanks for an elucidate history. Directly coming to your questions: This is not RA as the blood report is normal. It is difficult to say what caused this and what aggravated this. The recent treatment advised looks fine and should help you a lot. Rest to the affected part is a dictum no one can change. You should give a rest to the affected part. Since this is 2 months now: my advise would be to go for an MRI as it is better for the soft tissues ( synovium and cartilages). IT is good that you have already done for a CT scan. After the reports your Doctor may advise you a biopsy of the synovium. This will give a '''confirmatory'' diagnosis and ''guide'' for the best possible treatment. Regards,
Follow-up: What is the treatment for swollen painful ankle inspite of using steriods and painkillers? 7 hours later
Thanks Doctor for your advice. In regard to MRI, my doc said there is no requirement as the CT scan is fine and we should not go with the same to see the tissues... Moreover, i just want to confirm since it is not a RA problem then right not.....taking the medicine of the same should not have any side effect on me.... and secondly could this problem is simply a snyovitis ,,, as by one injecton of depomedrol lot of relief comes to me.. so what is thumb rule principle for curing synovitis .... is rest (for how many weeks) and taking anti inflammatory tablet.. Kindly advice Best Regards
Answered by Dr. T Chandrakant 1 hour later
Brief Answer: To get a diagnosis which caused synovitis Detailed Answer: Hi. Fine with your Doctor's opinion of CT scan, to repeat MRI has an added advantge. You are right in saying about: there may not be a point in taking suphasazapyrine. You can continue in taking other medicines. There is nothing like simply a synovitis. If there is synovitis , there is going to be a root cause. If one succeeds in getting the exact cause , the treatment can be guided perfectly and accordingly. Injecting depomedrol will help irrespective of the cause. (And you should not be a diabetic). Thumb rule : Find the reason ( root cause) which developed this; Synovitis is a sign of a disease - one has to find the disease which caused this. # 3 weeks rest is a good and anti-inflammatory tablets can be taken for 1 to 3 weeks, please take Ranitidine 150 mg twice a day to avoid gastric problems associated with them. All the medicines are relatively safe.
Follow-up: What is the treatment for swollen painful ankle inspite of using steriods and painkillers? 2 hours later
Thanks Doctor ... but recently I have read in newspaper that there is some viral fever in Delhi that give pains later like arthritis and some time becomes chronic ... in that case the docs are giving are giving medicine same as in RA treatment.. even my doc has given me tablets on similar line ... should I understand that I have the same viral fever... in that case do I need to take medicines of RA permanently though blood test and rest all rest do not show. secondly, initially I have got some relief from antibiotic and my both doctors in total gave me 15 days of antibiotic ... so can it be possible that since I had 15 days of antibiotic that's why in CT scan it never shown any infection... because in three weeks of rest with 2 injection of depomendrol and etova 2 tablets daily for 10 days ... I have recovered... I had very little pain in side of ankle.. and that pain when I press with my hand strongly... but when I put my complete pressure on my feet and start walking then the pain and swelling came back.. in the similar way like it was in initially .. by this what should I understand that due to excess pressure again it started because CT scan I got later and recently where there is no infection and either RA as doctor advise. Kindly make me understand what could be the reason of having this problem second time... 1) because of excess pressure put on ankle though it is not completely recovered 2) or because of some other problem Kindly guide Best Regards
Answered by Dr. T Chandrakant 2 hours later
Brief Answer: Yes- needs rest and if needed Biopsy. Detailed Answer: Very true. The viral fever causing the arthritis is a newer but a known complication and it usually affects the temporo-mandibular and knee joints, Ankle joints are known to be affected vary rarely. The treatment of RA and arthritis of any sort is almost similar (barring/except few medicines like sulphasalazine). So please do not worry about the medicines. The problem of arthritis is far bigger than the supposedly side-effects of any medicines. Ct scan can show infection only if there is collection and can not show the condition of the cartilages which are at the end of the bones forming a joint. ( Only MRI can). Yet CT scan is better than MRI for the study of the bones. Both are complimentary to each other so doing both is a better idea if money is not a constraint. 1) So, the probable reason as you are rightly thinking is due to excessive pressure put on the ankle as it takes a long time for the cartilages and other structures of the joints to completely heal. Minimum of 3 weeks rest is mandatory and increased if needed. You can also walk with the crutches later-on for non-weight bearing walking for 3 to 6 months as per the response of the joint to the medicine sand your own body resistance power. 2) to answer your second query: or because of some other problems: As I have already noted MRI helps in a better diagnosis. Synovial biopsy or guided FNAC ( Fine needle Aspiration Cytology) under sonography control can only be the most diagnostic in some cases.