[29F] With chronic swelling and pain in hands and feet

Patient Description

A 29-year-old female reports experiencing hard, painful swelling in the lower fingers, wrists, bottom of the feet, and ankles for over two years. The swelling initially occurred every few days but has progressed to almost daily, with each episode lasting one to two days. The patient notes that the swelling seems to resolve during her menstrual period. Pain associated with the swelling is rated as an 8 out of 10 at night, with light swelling present in the morning. The patient has been evaluated by a healthcare provider, with normal blood work results, and was prescribed hydroxychloroquine, which provided some relief but not to the desired extent. She has recently started birth control pills to manage symptoms, resulting in prolonged menstrual bleeding and increased pain. The patient has a history of Graves' disease but no family history of other autoimmune diseases. No other symptoms, such as joint stiffness, skin changes, or nail changes, have been reported.

Arora's Assessment

What might be happening

Based on the information you have provided, here are some possible explanations for your symptoms:

Hormonal Fluctuations: The fact that your swelling resolves with your menstrual period suggests a possible link to hormonal changes. Hormonal fluctuations can sometimes cause fluid retention and swelling, particularly in the extremities.
Autoimmune Conditions: Given your history of Graves' disease, it's possible that another autoimmune condition could be contributing to your symptoms. Conditions like rheumatoid arthritis or lupus can cause joint pain and swelling, although your normal blood work makes this less likely.
Medication Side Effects: You mentioned starting birth control pills, which can sometimes cause fluid retention and swelling as a side effect. This could potentially be contributing to your symptoms.
Idiopathic Edema: This is a condition where swelling occurs without a clear underlying cause. It can be related to various factors, including hormonal changes, diet, and lifestyle.

Typical treatments or testing might include further evaluation by a rheumatologist or endocrinologist, adjusting medications, or trying different therapies to manage symptoms.

What you can do

While it's important to follow up with your healthcare provider for a formal diagnosis and treatment plan, here are some steps you can take to help manage your symptoms:

Track Your Symptoms: Use MDandMe to journal your symptoms, track progress, and identify any potential triggers. This information can be valuable for your healthcare provider.
Lifestyle Modifications: Consider reducing salt intake, staying hydrated, and engaging in regular physical activity to help manage swelling.
Pain Management: Over-the-counter pain relievers, such as ibuprofen or acetaminophen, may help alleviate pain. However, consult with your healthcare provider before starting any new medication.
Monitor Hormonal Changes: Keep track of your menstrual cycle and any changes in symptoms related to hormonal fluctuations.

What you should look out for

Reasons to seek more urgent medical attention include:

If you notice any new or worsening symptoms, such as severe pain, redness, or warmth in the swollen areas.
If you experience any side effects from medications, such as prolonged bleeding or increased pain.
If your symptoms significantly impact your daily life or do not improve with current management strategies.

Remember, it's important to consult with a healthcare professional for a formal diagnosis and personalized treatment plan.

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1 mo ago

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