[19F] Experiencing joint pain, hives, and mouth ulcers

Patient Description

A 19-year-old female presents with moderate joint pain in fingers, toes, and wrists, lasting up to two days at a time and responsive to Motrin. She also reports hives on her joints and a rash on her elbows, knees, wrists, fingers, ankles, and feet, which is itchy and red, with both swollen bumps and red blotches, persisting for about a month. Additionally, she has one mouth ulcer on her lips, noticed within the past week. She has no known allergies, no recent fever or weight loss, and no morning stiffness or symmetrical joint involvement. She has no family history of autoimmune diseases except for a grandmother with celiac disease. She traveled to Italy a month ago but reports no known tick bites or consumption of unpasteurized dairy products. Her medication regimen includes daily Zoloft (150 mg), Ativan (0.5 mg as needed for panic attacks), Acyclovir, and Tri-Lo Mili, with no reported side effects. There is no past medical history of chronic illnesses or conditions.

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Arora's Assessment

What might be happening

Based on your symptoms, several conditions could be considered:

  • Systemic Lupus Erythematosus (SLE): This is an autoimmune disease that can cause a variety of symptoms including joint pain, skin rash, and mouth ulcers. The rash in SLE is typically photosensitive (worsens with sunlight exposure) and can appear as a malar rash (butterfly-shaped rash across the cheeks and nose), but hives are not uncommon. Joint pain in SLE is typically symmetrical and can affect any joint, but is most common in the hands and wrists.

    • Diagnosis is typically made through a combination of clinical symptoms and specific blood tests. Treatment usually involves medications to suppress the immune system and manage symptoms.
  • Rheumatoid Arthritis (RA): This is another autoimmune disease that primarily affects the joints. It can cause joint pain, swelling, and stiffness. However, RA usually affects the joints symmetrically (e.g., both hands or both knees), and the joint pain is typically worse in the morning.

    • Diagnosis is made through a combination of clinical symptoms, blood tests, and imaging studies. Treatment typically involves medications to suppress the immune system and manage symptoms.
  • Chronic Urticaria: This is a condition characterized by the development of hives, typically in response to an allergen, but sometimes the cause is unknown. Hives can appear anywhere on the body and are typically very itchy.

    • Treatment typically involves avoiding known triggers and taking antihistamines to manage symptoms.
  • Behcet's Disease: This is a rare disorder that causes blood vessel inflammation throughout your body. Symptoms can include mouth sores, joint pain, and a rash.

    • Diagnosis is typically made based on clinical symptoms. Treatment usually involves medications to reduce inflammation and suppress the immune system.

What you can do

  1. Keep a symptom diary: Note down when your symptoms occur, how long they last, and any potential triggers (e.g., foods, stress, sunlight). This can help identify patterns and potential triggers.
  2. Over-the-counter pain relief: Non-prescription pain relievers such as ibuprofen (Motrin) can help manage your joint pain.
  3. Topical creams: Over-the-counter creams and ointments can help manage the itchiness associated with your hives.
  4. Stay hydrated and maintain a balanced diet: This can help support your overall health.

What you should look out for

Please seek immediate medical attention if you experience:

  • Severe joint pain or swelling
  • Difficulty breathing or swallowing
  • Severe rash or hives
  • Fever, chills, or unexplained weight loss

Remember, this advice is intended to be general in nature, and specific causes may not apply to your situation. Always consult with a healthcare provider for appropriate examination, testing, and care recommendations.

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People Also Ask


What are the common symptoms of Systemic Lupus Erythematosus (SLE)?

Common symptoms of SLE include joint pain, skin rashes (often photosensitive), mouth ulcers, fatigue, and sometimes fever. The joint pain is often symmetrical and can affect any joint, but is most common in the hands and wrists.


How is Rheumatoid Arthritis (RA) different from other types of arthritis?

Rheumatoid Arthritis (RA) is an autoimmune disease that primarily affects the joints symmetrically, causing pain, swelling, and stiffness, especially in the morning. It differs from osteoarthritis, which is due to wear and tear, and typically affects joints asymmetrically.


What are the typical triggers for chronic urticaria?

Typical triggers for chronic urticaria include certain foods, medications, stress, infections, and sometimes physical stimuli like pressure, temperature changes, or sunlight. However, in many cases, the exact cause remains unknown.


What are the key symptoms of Behcet's Disease?

Key symptoms of Behcet's Disease include recurrent mouth sores, genital sores, eye inflammation, skin rashes, and joint pain. It is a rare disorder that causes blood vessel inflammation throughout the body.


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