[33F] With chronic joint pain, neuropathy, and multiple other symptoms
Patient Description
A 33-year-old female presents with chronic joint pain, neuropathy, brain fog, fatigue, and headaches. The joint pain affects her knees, hands, feet, wrists, and back. The pain in her feet is stabbing and has been ongoing for 25 years, the hand pain is throbbing and achy and started 20 years ago (worsening 5 years ago), the knee pain is achy and weak and started 6 years ago, and the wrist pain is sharp. Additionally, she experiences lower back pain described as achy and squeezing, exacerbated by walking, bending, or lifting, and tailbone pain described as intense stabbing, exacerbated by sitting up straight. The severity of her pain ranges from 4 (with over-the-counter meds and minimal movement) to 7-8 (with normal daily activities or more strenuous activities) and reaches a 10 for tailbone pain when sitting up straight. Aleve provides minimal relief. She also experiences numbness, tingling, swelling, and burning in her feet and hands, especially when the pain is severe. She reports stiffness in her joints, particularly in the morning, and muscle weakness in the affected areas. Her symptoms significantly impact daily activities, including gripping objects, walking, and climbing stairs, and she has stopped driving due to the pain. She has experienced recent weight gain, fevers, night sweats, and changes in balance and coordination. Her medical history includes carpal tunnel syndrome (diagnosed at 27), insomnia (since age 16), depression (since age 12), and anxiety (since age 12). She is currently taking Lexapro, Wellbutrin, and Ambien CR, along with Aleve, biotin, vitamin D, folic acid, fiber, Claritin, and an allergy nose spray. She takes delta 8 gummies at night for insomnia. She has no known family history of autoimmune diseases and no recent travel. Mood stabilizers cause ocular gyro crisis.
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Arora's Assessment
What might be happening
It is likely that your symptoms are related to multiple issues, including existing diagnoses. If you have more questions, we can continue chatting.
Joint Pain and Neuropathy
- Rheumatoid Arthritis (RA): Given the chronic nature of your joint pain, swelling, and stiffness, RA is a possibility. RA is an autoimmune disorder that causes inflammation in the joints, leading to pain and swelling. It often affects the hands, wrists, and knees.
- Osteoarthritis (OA): This is another form of arthritis that could explain your joint pain, especially given the long duration. OA is caused by wear and tear on the joints and can lead to pain, swelling, and stiffness.
- Peripheral Neuropathy: Your symptoms of numbness, tingling, and burning pain in your hands and back could be due to peripheral neuropathy. This condition involves damage to the peripheral nerves and can cause pain, numbness, and weakness.
Unifying Diagnoses
- Fibromyalgia: This condition could explain your widespread pain, fatigue, and brain fog. Fibromyalgia is characterized by chronic pain in multiple areas of the body, along with fatigue and cognitive difficulties.
- Chronic Inflammatory Response Syndrome (CIRS): Given your history of multiple chronic symptoms, CIRS could be a possibility. This condition is often triggered by exposure to biotoxins and can cause a wide range of symptoms, including joint pain, fatigue, and cognitive issues.
Typical Treatments and Testing
- Rheumatoid Arthritis: Blood tests (e.g., rheumatoid factor, anti-CCP antibodies), imaging studies (X-rays, MRI), and physical examination. Treatment may include disease-modifying antirheumatic drugs (DMARDs), biologics, and physical therapy.
- Osteoarthritis: Imaging studies (X-rays, MRI) and physical examination. Treatment may include pain relievers, anti-inflammatory medications, physical therapy, and lifestyle modifications.
- Peripheral Neuropathy: Nerve conduction studies, electromyography (EMG), and blood tests. Treatment may include medications (e.g., gabapentin, which you are already taking), physical therapy, and addressing underlying causes.
- Fibromyalgia: Diagnosis is often based on symptoms and physical examination. Treatment may include medications (e.g., pain relievers, antidepressants), physical therapy, and lifestyle changes.
- CIRS: Diagnosis may involve blood tests, imaging studies, and symptom assessment. Treatment may include medications, lifestyle changes, and addressing environmental triggers.
What you can do
Joint Pain and Neuropathy
- Consult a Rheumatologist: Given the chronic nature and severity of your joint pain, it would be beneficial to consult a rheumatologist for a thorough evaluation and potential diagnosis of conditions like RA or OA.
- Pain Management: Continue using Aleve as needed, but be cautious about long-term use. Consider discussing other pain management options with your doctor, such as prescription medications or physical therapy.
- Physical Therapy: A physical therapist can help you with exercises and techniques to manage pain and improve joint function.
- Lifestyle Modifications: Maintain a healthy weight, engage in low-impact exercises (e.g., swimming, walking), and use assistive devices if needed to reduce strain on your joints.
Numbness and Tingling
- Neurologist Consultation: Consider seeing a neurologist for a thorough evaluation of your neuropathy symptoms. They may recommend nerve conduction studies or other tests to determine the cause.
- Gabapentin: Continue taking gabapentin as prescribed for your carpal tunnel syndrome. Discuss with your doctor if you need any adjustments in dosage or additional treatments.
Back Pain
- Lower Back Pain: Avoid activities that worsen the pain, such as heavy lifting or prolonged bending. Consider using a lumbar support cushion when sitting and practice good posture.
- Tailbone Pain: Use a cushion with a cut-out section to relieve pressure on your tailbone when sitting. Avoid sitting for long periods and try to maintain good posture.
General Tips
- Symptom Journal: Use MDandMe to journal your symptoms, track progress, get insights, and share longitudinal medical notes with your provider. This can help in identifying patterns and triggers for your symptoms.
- Healthy Lifestyle: Maintain a balanced diet, stay hydrated, and get regular exercise. These can help improve overall health and potentially alleviate some symptoms.
What you should look out for
Given the severity of your symptoms and the possibility of life-threatening causes, you should seek medical care as soon as you can. Reasons to seek care even more urgently include:
- Severe Pain: If your pain becomes unbearable or significantly worsens.
- New Symptoms: If you develop new symptoms such as shortness of breath, chest
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5 mo ago