[41F] With chronic pain and suspected psoriatic arthritis

Patient Description

A 41-year-old female has been experiencing chronic pain in her right hand, left wrist, lower back, knees, ankles, and shoulders for the past 14 months. The pain is described as very intense, reaching a 10 on a scale of 1-10, and occurs in episodes lasting 3-8 days. Cold weather and stress exacerbate the pain. The patient has tried Aleve without significant relief and is starting Celebrex at 200mg twice daily. A healthcare provider suspects psoriatic arthritis. The patient also experienced significant hair loss on her scalp at the onset of these symptoms, which has since regrown. She reports changes in her nails, describing them as thicker and unusual, and notes dryness and pain in her elbows and toes. Her medical history includes anxiety, agoraphobia, depression, and asthma, diagnosed around age 10, and endometriosis, which led to a hysterectomy at age 35. She uses a lidocaine patch and diclofenac as needed and has hydroxyzine and citalopram for anxiety. She takes fish oil, a multivitamin, vitamin D, and Move Free supplements. There are no known allergies to medications.

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Arora's Assessment

What might be happening

Based on the symptoms and information you've provided, it seems that you may be experiencing symptoms consistent with Psoriatic Arthritis. This condition is an inflammatory arthritis associated with psoriasis, which can cause joint pain, stiffness, and swelling. It often affects the joints in the fingers, toes, and spine, and can also lead to changes in the nails, such as thickening or pitting. The dry skin on your elbows and toes could be related to psoriasis, which often accompanies psoriatic arthritis.

  • Typical Treatments: Treatment for psoriatic arthritis often includes nonsteroidal anti-inflammatory drugs (NSAIDs) like Celebrex to reduce pain and inflammation. Disease-modifying antirheumatic drugs (DMARDs) or biologics may be prescribed to slow disease progression. Topical treatments can help manage skin symptoms.

What you can do

  1. Medication Adherence: Start taking Celebrex as prescribed by your healthcare provider. It may help reduce inflammation and pain.

  2. Symptom Tracking: Use MDandMe to journal your symptoms, track your progress, and share insights with your healthcare provider. This can help in adjusting your treatment plan as needed.

  3. Lifestyle Adjustments: Engage in regular, gentle exercise to maintain joint flexibility and strength. Low-impact activities like swimming or yoga can be beneficial.

  4. Stress Management: Since stress can exacerbate symptoms, consider stress-reduction techniques such as meditation, deep breathing exercises, or counseling.

  5. Skin Care: Keep your skin moisturized to manage dryness. Use gentle, fragrance-free products to avoid irritation.

What you should look out for

  • Worsening Symptoms: If you notice increased joint pain, swelling, or stiffness, or if new symptoms develop, contact your healthcare provider.

  • Side Effects: Be aware of any side effects from new medications, such as Celebrex, and report them to your doctor.

  • Infection Signs: If you experience signs of infection, such as fever or redness and warmth around a joint, seek medical attention promptly.

Remember, while this information can be helpful, it's important to follow up with your healthcare provider for a formal diagnosis and personalized treatment plan.

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2 mo ago

People Also Ask

What are the common symptoms of psoriatic arthritis?

Common symptoms of psoriatic arthritis include joint pain, stiffness, and swelling, particularly in the fingers, toes, and spine. It can also cause changes in the nails, such as thickening or pitting, and may be accompanied by skin symptoms like psoriasis.

How can stress affect psoriatic arthritis symptoms?

Stress can exacerbate psoriatic arthritis symptoms by increasing inflammation and pain levels. Managing stress through techniques like meditation, deep breathing exercises, or counseling can help reduce symptom severity.

What are the potential side effects of taking Celebrex?

Potential side effects of Celebrex include stomach pain, heartburn, diarrhea, constipation, gas, nausea, and dizziness. More serious side effects can include cardiovascular issues, gastrointestinal bleeding, and kidney problems. It's important to report any unusual symptoms to your healthcare provider.

How can lifestyle changes help manage psoriatic arthritis?

Lifestyle changes such as engaging in regular, gentle exercise can help maintain joint flexibility and strength. Low-impact activities like swimming or yoga are particularly beneficial. Additionally, managing stress and maintaining a healthy diet can support overall health and potentially reduce symptom severity.

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