[18F] With SI joint pain, high heart rate, and multiple systemic symptoms
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Patient Description
An 18-year-old female has been experiencing SI joint pain for about a year and a half. The pain varies between sharp, dull, and aching, with a severity of 9 out of 10 at its worst. Pain episodes occur approximately once every two weeks and typically last for a day, but the current episode has lasted at least two days. Activities like bending over, walking, standing, putting her knee to her chest, and turning over in bed worsen the pain, while laying down and not moving helps alleviate it. X-rays revealed mild scoliosis and inflammation in the SI joints. She has tried prescribed anti-inflammatories and muscle relaxers, which provide some relief, and steroid injections, which alleviated the pain for a couple of months before it returned. No swelling, redness, or warmth around the SI joint area has been noted.
Additionally, she has been experiencing a consistently high heart rate for at least a couple of months, with a resting heart rate around 100 and it increasing to 140 with minimal activity like walking across the house. She also reports joint pain in her knees and wrists, fatigue, weight gain, heat intolerance, and exercise intolerance. Other symptoms include thinning hair, tremors, and chronic constipation. Her medical history includes depression, anxiety, ADHD, and asthma, all diagnosed around the age of 12 or 13. Current medications include etodolac 500 mg daily, lurasidone 60 mg daily, and as-needed methocarbamol 500 mg, naproxen 500 mg, and trazodone 100 mg. She has no known allergies to medications.
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Arora's Assessment
What might be happening
Based on the symptoms you've described, there are a few potential diagnoses and unifying conditions that could explain your symptoms:
SI Joint Pain
- Sacroiliitis: Inflammation of one or both of your sacroiliac joints, which connect your lower spine to your pelvis. This condition can cause pain in your buttocks or lower back, and it can extend down one or both legs. Pain can be aggravated by prolonged standing or stair climbing.
- Spondyloarthritis: A group of inflammatory diseases that can cause arthritis, including ankylosing spondylitis, which often affects the spine and the sacroiliac joints.
High Heart Rate, Fatigue, Heat Intolerance, and Exercise Intolerance
- Hyperthyroidism: An overactive thyroid gland can cause symptoms like a high heart rate, fatigue, heat intolerance, weight loss, and tremors. Given your thinning hair and chronic constipation, thyroid dysfunction is a possibility.
- POTS (Postural Orthostatic Tachycardia Syndrome): This condition affects circulation (blood flow) and can cause an increased heart rate when you move from lying down to standing up, along with fatigue and exercise intolerance.
Joint Pain in Knees and Wrists
- Inflammatory Arthritis: Conditions like rheumatoid arthritis or psoriatic arthritis can cause joint pain and inflammation in multiple joints, including the knees and wrists.
Weight Gain and Chronic Constipation
- Hypothyroidism: An underactive thyroid can cause weight gain, fatigue, constipation, and other symptoms. This is another thyroid-related condition that could be considered.
Unifying Diagnoses
- Thyroid Dysfunction: Both hyperthyroidism and hypothyroidism can cause a wide range of symptoms that overlap with what you're experiencing, including changes in heart rate, fatigue, weight changes, and hair thinning.
- Autoimmune Disorders: Conditions like lupus or rheumatoid arthritis can cause systemic symptoms affecting multiple parts of the body, including joint pain, fatigue, and other systemic symptoms.
What you can do
SI Joint Pain
- Consult a Specialist: See a rheumatologist or an orthopedic specialist for a thorough evaluation. They may recommend imaging studies like MRI or CT scans for a more detailed look at your SI joints.
- Physical Therapy: Engage in physical therapy to strengthen the muscles around your SI joint and improve flexibility.
- Pain Management: Continue with prescribed anti-inflammatories and muscle relaxers as needed. You might also consider discussing other pain management options with your doctor, such as different types of injections or medications.
High Heart Rate, Fatigue, and Exercise Intolerance
- See a Cardiologist: A cardiologist can evaluate your heart rate issues and may recommend tests like an ECG or Holter monitor to assess your heart's activity.
- Endocrinologist Consultation: Given the possibility of thyroid dysfunction, seeing an endocrinologist for a thorough evaluation, including blood tests to check thyroid function, would be beneficial.
Joint Pain in Knees and Wrists
- Rheumatologist Consultation: A rheumatologist can evaluate for inflammatory arthritis and recommend appropriate treatments, which may include medications to reduce inflammation and manage pain.
Weight Gain and Chronic Constipation
- Diet and Exercise: Maintain a balanced diet rich in fiber to help with constipation. Regular exercise can also help manage weight and improve overall health.
- Thyroid Function Tests: Blood tests to check your thyroid hormone levels can help diagnose or rule out thyroid dysfunction.
General Tips
- Symptom Journal: Use MDandMe to journal your symptoms, track progress, and get insights. This can be very helpful when discussing your condition with healthcare providers.
- Stay Hydrated: Drink plenty of water to help with constipation and overall health.
- Rest and Self-Care: Ensure you get adequate rest and practice self-care to manage fatigue and stress.
What you should look out for
Given the severity and complexity of your symptoms, it's important to seek medical care as soon as possible. Reasons to seek care even more urgently include:
- Severe or Worsening Pain: If your pain becomes unbearable or significantly worsens.
- New or Worsening Symptoms: If you develop new symptoms like shortness of breath, chest pain, or fainting.
- Signs of Infection: If you notice any signs of infection, such as fever, chills, or redness and warmth around the joints.
Remember, while I can provide information and suggestions, it's crucial to consult with real healthcare professionals to receive a formal diagnosis and appropriate treatment. If you have more questions or need further assistance, feel free to continue the conversation.
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4 mo ago