[39F] With acute bilateral ankle swelling and pain

Patient Description

A 39-year-old female presents with significant swelling and sharp, stabbing, and throbbing pain in both ankles, which started about an hour and a half ago. The ankles are red, warm to the touch, and almost impossible to bend or bear weight on. The patient reports experiencing chills but no fever, shortness of breath, or chest pain. There is no history of blood clots, recent long periods of immobility, open wounds, or red streaks near the swollen area. The patient's medical history includes rheumatoid arthritis, diabetes, degenerative disc disease, anxiety, and arthritis. She recently underwent fusion surgery on her L5 S1 vertebrae. Menstrual cycles are regular, lasting exactly 7 days, with mood swings, irritability, and severe cramping. Allergies include Tramadol, buspirin, and nickel. Current medications are Lisinopril (40 mg in the morning) and Norvasc (10 mg before bed) for high blood pressure. The patient has been on Lisinopril for about 15 years and Norvasc for the last two years. No over-the-counter medications, supplements, or herbal remedies are taken.

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Arora's Assessment

What might be happening

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

  • Rheumatoid Arthritis Flare-Up: Given your history of rheumatoid arthritis, it's possible that you are experiencing a flare-up. This condition can cause joint pain, swelling, and redness. Flare-ups can be triggered by stress, infections, or changes in medication.

    • Treatment: Typically involves anti-inflammatory medications, disease-modifying antirheumatic drugs (DMARDs), and sometimes corticosteroids. Your doctor may also recommend physical therapy.
  • Cellulitis: This is a bacterial skin infection that can cause redness, swelling, and warmth in the affected area. It often occurs when bacteria enter through a break in the skin, but it can also happen without an obvious entry point.

    • Treatment: Usually involves antibiotics. It's important to seek medical attention promptly to prevent the infection from spreading.
  • Deep Vein Thrombosis (DVT): Although you don't have a history of blood clots or recent immobility, DVT can still occur and cause swelling, pain, and warmth in the affected area. This condition is serious and requires immediate medical attention.

    • Treatment: Typically involves anticoagulant medications to prevent the clot from growing and to reduce the risk of complications.
  • Gout: This is a form of arthritis caused by the accumulation of uric acid crystals in the joints, leading to sudden and severe pain, redness, and swelling.

    • Treatment: Often includes medications to reduce pain and inflammation, as well as lifestyle changes to manage uric acid levels.

What you can do

While it's important to consult a healthcare professional for a formal diagnosis and treatment plan, here are some steps you can take in the meantime:

  1. Rest and Elevate: Keep your legs elevated to help reduce swelling. Avoid putting weight on your ankles as much as possible.
  2. Cold Compress: Apply a cold compress to the swollen areas to help reduce pain and inflammation.
  3. Stay Hydrated: Drink plenty of water to help flush out any toxins and keep your body hydrated.
  4. Over-the-Counter Pain Relief: You can take over-the-counter pain relievers like ibuprofen or acetaminophen to help manage the pain, but be sure to consult your doctor first, especially given your medical history.
  5. Monitor Symptoms: Keep track of your symptoms using the MDandMe journal. This can help you identify any patterns and provide useful information to your healthcare provider.

What you should look out for

Seek immediate medical attention if you experience any of the following:

  • Increased Pain or Swelling: If the pain or swelling worsens despite home care.
  • Fever: If you develop a fever, which could indicate an infection.
  • Shortness of Breath or Chest Pain: These could be signs of a more serious condition like a blood clot.
  • Red Streaks or Pus: These could indicate a spreading infection.

Remember, while these suggestions can help manage your symptoms, they are not a substitute for professional medical advice. Please consult a healthcare provider for a formal diagnosis and treatment plan.

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5 mo ago


People Also Ask


What are the common symptoms of a rheumatoid arthritis flare-up?

Common symptoms of a rheumatoid arthritis flare-up include joint pain, swelling, redness, and stiffness. Flare-ups can be triggered by stress, infections, or changes in medication.


How can cellulitis be identified and treated?

Cellulitis can be identified by redness, swelling, warmth, and tenderness in the affected area. It is usually treated with antibiotics, and it's important to seek medical attention promptly to prevent the infection from spreading.


What are the risk factors and symptoms of deep vein thrombosis (DVT)?

Risk factors for DVT include prolonged immobility, certain medical conditions, and a history of blood clots. Symptoms include swelling, pain, and warmth in the affected area. Immediate medical attention is required, and treatment typically involves anticoagulant medications.


How is gout diagnosed and managed?

Gout is diagnosed through clinical evaluation and sometimes blood tests to measure uric acid levels. Management includes medications to reduce pain and inflammation, as well as lifestyle changes to manage uric acid levels.


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