[42F] With joint pain, weakness, and skin issues

Patient Description

A 42-year-old female presents with bilateral elbow and wrist pain and weakness persisting for approximately eight weeks. The pain is described as similar to hitting the funny bone, rated around 5-6/10, and worsens in the morning or when lifting objects. The patient reports difficulty performing daily tasks, such as picking up her child, due to weakness. Additionally, she experiences dry, cracking skin on the heels and balls of her feet, causing pain when walking. Despite using various moisturizing treatments, the condition persists. The patient also notes stiffness in her joints, particularly in the morning, and brittle, splitting nails. She has recently been diagnosed with low iron and thyroid levels, receiving iron infusions but not yet on thyroid medication. Her medical history includes depression managed with Wellbutrin and occasional use of Motrin for pain. She has an allergy to codeine. Family history is significant for autoimmune disease, specifically myositis of the lungs in her father.

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Arora's Assessment

What might be happening

Based on the symptoms you've described, there are a few potential explanations for what you might be experiencing:

  1. Joint Pain and Weakness: The pain and weakness in your elbows and wrists, along with morning stiffness, could be indicative of a condition like rheumatoid arthritis or another inflammatory joint condition. These conditions can cause joint pain, stiffness, and weakness, particularly in the morning or after periods of inactivity. Given your family history of autoimmune disease, this possibility should be considered.

  2. Thyroid Issues: Your low thyroid levels (hypothyroidism) can contribute to joint pain, muscle weakness, fatigue, and changes in your skin and nails. Hypothyroidism can also cause dry skin, which might be contributing to the issues with your feet.

  3. Skin and Nail Changes: The dryness and cracking of your feet, along with nail changes, could be related to your thyroid condition or could be a separate dermatological issue, such as eczema or psoriasis.

  4. Iron Deficiency: While your iron infusions are addressing your low iron levels, iron deficiency can also contribute to fatigue and weakness, which might be exacerbating your symptoms.

What you can do

Joint Pain and Weakness:

  • Consult a healthcare provider: It's important to see a doctor for a thorough evaluation of your joint pain and weakness. They may recommend blood tests or imaging studies to determine the cause and suggest appropriate treatment.
  • Manage pain: Continue using over-the-counter pain relievers like Motrin or Tylenol as needed, but be mindful of the recommended dosages to avoid side effects.
  • Gentle exercises: Engage in gentle stretching and strengthening exercises to maintain joint mobility and strength. A physical therapist can provide guidance on appropriate exercises.

Dry, Cracking Feet:

  • Moisturize regularly: Continue moisturizing your feet with thick creams or ointments, especially after bathing. Consider using a urea-based cream, which can be more effective for severe dryness.
  • Protect your feet: Wear comfortable, supportive shoes and consider using cushioned insoles to reduce pressure on your feet.
  • Consult a dermatologist: If your feet do not improve, a dermatologist can provide specialized treatments or identify any underlying skin conditions.

Thyroid and Iron Levels:

  • Follow up with your doctor: Discuss your thyroid levels with your healthcare provider to determine if thyroid medication is needed. Proper management of your thyroid condition can help alleviate some of your symptoms.
  • Continue iron infusions: Ensure you complete your iron infusion treatment as prescribed to address your iron deficiency.

General Health:

  • Track your symptoms: Use MDandMe to journal your symptoms, track progress, and share insights with your healthcare provider. This can help in managing your condition and adjusting treatments as needed.

What you should look out for

  • Worsening symptoms: If you notice increased pain, swelling, or redness in your joints, or if your symptoms significantly worsen, seek medical attention promptly.
  • New symptoms: Be alert for any new symptoms, such as fever, unexplained weight loss, or severe fatigue, and report them to your healthcare provider.
  • Side effects: Monitor for any side effects from medications, especially if you start new treatments for your thyroid or joint pain.

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

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People Also Ask


What could be causing my joint pain and weakness, especially in the morning?

Joint pain and weakness, particularly in the morning, could be caused by conditions like rheumatoid arthritis or other inflammatory joint diseases. These conditions often lead to stiffness and pain after periods of inactivity. Given a family history of autoimmune diseases, it's important to consult a healthcare provider for a thorough evaluation.


How can low thyroid levels affect my skin and nails?

Low thyroid levels, or hypothyroidism, can lead to changes in skin and nails, such as dryness, cracking, and brittleness. This is because thyroid hormones play a crucial role in maintaining skin and nail health. Managing thyroid levels with appropriate medication can help alleviate these symptoms.


What are some effective treatments for dry, cracking skin on my feet?

For dry, cracking skin on the feet, regular moisturizing with thick creams or ointments, especially those containing urea, can be effective. It's also important to protect the feet with comfortable shoes and cushioned insoles. If the condition persists, consulting a dermatologist for specialized treatment is recommended.


How does iron deficiency contribute to fatigue and weakness?

Iron deficiency can lead to fatigue and weakness because iron is essential for producing hemoglobin, which carries oxygen in the blood. Without enough iron, the body struggles to get sufficient oxygen to tissues, leading to these symptoms. Iron infusions or supplements can help address this deficiency.


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