[28F] With swollen hands, feet, and dramatic weight loss

Patient Description

A 28-year-old female presents with swollen hands that are painful and red in the mornings, which improve with cold exposure. This swelling has been occurring for about a week. She also reports mild swelling in her feet for the past week, accompanied by numbness and pain for the past 2-3 months. Additionally, she has experienced dramatic weight loss recently. The patient reports occasional knee and leg pain, fever, fatigue, nausea, and tingling or burning sensations in her hands and feet. She denies chest pain, shortness of breath, and changes in vision. Her medical history includes asthma in childhood, depression, anxiety, and borderline personality disorder (BPD) diagnosed at age 22. She is allergic to sulfur and is currently taking Adderall, Zoloft, and Klonopin once daily. She does not use tobacco, alcohol, or recreational drugs, and there is no family history of autoimmune disorders or chronic illnesses. The patient is not up to date with vaccinations and has not been exposed to new environments, chemicals, or allergens recently.

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Arora's Assessment

What might be happening

Based on the symptoms you've described, there are a few potential diagnoses that could explain your condition:

  1. Rheumatoid Arthritis (RA):

    • Rationale: RA is an autoimmune disorder that can cause joint pain, swelling, and stiffness, particularly in the hands and feet. The morning stiffness and swelling you described are common symptoms of RA.
    • Typical Treatments/Testing: Blood tests to check for inflammatory markers and specific antibodies, imaging tests like X-rays or MRIs, and medications such as NSAIDs, corticosteroids, and disease-modifying antirheumatic drugs (DMARDs).
  2. Peripheral Neuropathy:

    • Rationale: The tingling, burning sensations, and numbness in your hands and feet could be due to peripheral neuropathy, which is often caused by diabetes, vitamin deficiencies, or other underlying conditions.
    • Typical Treatments/Testing: Blood tests to check for underlying conditions, nerve conduction studies, and medications to manage pain and symptoms.
  3. Unifying Diagnosis:

    • Systemic Lupus Erythematosus (SLE): This autoimmune disease can cause a wide range of symptoms, including joint pain, swelling, fatigue, fever, and weight loss. It can also affect multiple organ systems.
    • Typical Treatments/Testing: Blood tests to check for specific antibodies, urine tests, imaging tests, and medications such as NSAIDs, corticosteroids, and immunosuppressive drugs.

What you can do

Swollen Hands and Feet:

  • See a doctor: It's important to consult a healthcare provider to determine the underlying cause of your swelling and pain. They may recommend blood tests, imaging studies, or referrals to specialists.
  • At home:
    • Apply cold packs to reduce swelling and pain.
    • Elevate your hands and feet when possible to reduce swelling.
    • Avoid activities that exacerbate the pain and swelling.

Dizziness and Nausea:

  • See a doctor: These symptoms could be related to an underlying condition such as peripheral neuropathy or an autoimmune disorder. Your doctor may recommend further testing.
  • At home:
    • Stay hydrated and avoid sudden movements that could worsen dizziness.
    • Eat small, frequent meals to help manage nausea.

Dramatic Weight Loss:

  • See a doctor: Unintentional weight loss can be a sign of a serious underlying condition. Your doctor may recommend blood tests, imaging studies, and a thorough medical evaluation.
  • At home:
    • Keep a food diary to track your intake and any associated symptoms.
    • Ensure you are eating a balanced diet with adequate calories and nutrients.

General Tips:

  • Journal your symptoms: Use MDandMe to journal your symptoms, track progress, get insights, and share longitudinal medical notes with your provider.
  • Stay informed: Educate yourself about potential conditions and treatments, but always consult with a healthcare provider for a formal diagnosis and treatment plan.

What you should look out for

Given the severity of your symptoms and the possibility of serious underlying conditions, you should seek medical care as soon as possible. Reasons to seek care even more urgently include:

  • Severe or worsening pain, swelling, or stiffness in your joints.
  • Persistent or worsening dizziness or nausea.
  • Significant changes in weight or appetite.
  • New or worsening symptoms such as shortness of breath, chest pain, or severe fatigue.

Remember, while I can provide information and suggestions, it's crucial to consult with a healthcare professional for a formal diagnosis and appropriate treatment. If you have any more questions or need further assistance, feel free to continue the conversation.

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People Also Ask


What are the common symptoms of Rheumatoid Arthritis?

Common symptoms of Rheumatoid Arthritis include joint pain, swelling, stiffness, particularly in the hands and feet, morning stiffness, and fatigue. It is an autoimmune disorder that primarily affects the joints.


How is Peripheral Neuropathy diagnosed and treated?

Peripheral Neuropathy is diagnosed through blood tests to identify underlying conditions, nerve conduction studies, and sometimes imaging tests. Treatment often involves managing the underlying cause, pain relief medications, and lifestyle changes.


What are the potential causes of dramatic weight loss?

Dramatic weight loss can be caused by a variety of factors including metabolic disorders, chronic illnesses, malabsorption syndromes, mental health conditions, and certain medications. It is important to consult a healthcare provider for a thorough evaluation.


How can Systemic Lupus Erythematosus affect the body?

Systemic Lupus Erythematosus (SLE) can affect multiple organ systems, causing symptoms such as joint pain, swelling, fatigue, fever, skin rashes, and weight loss. It is an autoimmune disease that can lead to inflammation and damage in various parts of the body.


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