[43F] With sore joints, swollen lymph node, and other symptoms

Patient Description

A 43-year-old female presents with sore joints, particularly in the hips, which started suddenly a week ago. The pain is severe, rated 7 out of 10, constant, and somewhat relieved by laying down and taking Advil. There is no swelling, redness, or warmth in the hip area. The patient also reports a swollen lymph node noticed today, which is hard, mildly tender, and singular. Additional symptoms include diarrhea, nausea, sore muscles, and night sweats. The patient denies fever, unexplained weight loss, rashes, skin changes, and abdominal pain but reports unusual fatigue. There has been no recent travel or exposure to sick individuals. The patient has a 20-year history of smoking a pack a day. Current medications include Potassium, Effexor, atorvastatin, mirtazapine, hydrochlorothiazide, Metformin, Humira, and lisinopril. The Humira dosage was recently increased to 0.08 every other week, though the patient sometimes forgets to take it. Family history includes psoriasis. No known drug allergies.

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Arora's Assessment

What might be happening

Based on the symptoms and history you've provided, here are some possible explanations for your condition:

1. Infection or Inflammatory Condition

  • Swollen Lymph Node, Diarrhea, Nausea, Night Sweats, and Fatigue: These symptoms could indicate an infection or an inflammatory condition. Given your recent increase in Humira dosage, it's possible that your immune system might be more susceptible to infections. Humira is an immunosuppressant, which can increase the risk of infections.
  • Typical Treatments and Testing: Your doctor might order blood tests, imaging studies, or a biopsy of the swollen lymph node to determine the cause. Antibiotics or antiviral medications might be prescribed if an infection is identified.

2. Autoimmune or Rheumatologic Condition

  • Sore Joints and Muscles: These symptoms, along with your family history of psoriasis, could suggest an autoimmune or rheumatologic condition such as psoriatic arthritis or another type of inflammatory arthritis.
  • Typical Treatments and Testing: Your doctor might recommend blood tests to check for markers of inflammation and autoimmune activity. Imaging studies like X-rays or MRIs might also be used. Treatment could include anti-inflammatory medications, physical therapy, or adjustments to your current medications.

3. Medication Side Effects

  • Diarrhea, Nausea, and Fatigue: These could be side effects of your medications, particularly Metformin and Humira. It's important to discuss these symptoms with your doctor to see if any adjustments are needed.
  • Typical Treatments and Testing: Your doctor might review your medication regimen and make adjustments as needed. They might also recommend supportive care for symptom relief.

What you can do

Sore Joints and Muscles

  • See a Doctor: Given the severity and sudden onset of your hip pain, it's important to consult a healthcare provider. They might recommend imaging studies or refer you to a specialist.
  • At Home: Continue taking Advil as needed, but do not exceed the recommended dosage. Rest and avoid activities that exacerbate the pain. Applying ice or heat might also provide relief.

Swollen Lymph Node, Diarrhea, Nausea, Night Sweats, and Fatigue

  • See a Doctor: These symptoms could indicate an infection or another serious condition, especially given your use of Humira. It's important to get a thorough evaluation, which might include blood tests and imaging studies.
  • At Home: Stay hydrated, especially if you have diarrhea. Eat small, bland meals to help with nausea. Keep a record of your symptoms using the MDandMe journal to track any changes and share this information with your healthcare provider.

What you should look out for

Given the complexity and severity of your symptoms, you should seek medical care as soon as possible. Reasons to seek care even more urgently include:

  • Fever or Chills: These could indicate an infection that needs prompt treatment.
  • Severe or Worsening Pain: If your hip pain becomes unbearable or spreads to other areas.
  • New or Worsening Symptoms: Such as shortness of breath, chest pain, or significant changes in bowel movements.
  • Signs of Severe Infection: Such as high fever, severe fatigue, or confusion.

Remember, while I can provide information and suggestions, it's crucial to consult with a healthcare professional for a formal diagnosis and appropriate treatment. If you have more questions or need further assistance, feel free to continue the conversation.

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3 mo ago


People Also Ask


What could be causing my sudden severe hip pain without swelling or redness?

Sudden severe hip pain without swelling or redness could be due to an inflammatory condition or an autoimmune disorder like psoriatic arthritis, especially given your family history. It's important to consult a healthcare provider for a proper diagnosis.


How does Humira increase the risk of infections, and what should I watch out for?

Humira is an immunosuppressant, which means it can lower your immune system's ability to fight infections. This makes you more susceptible to infections. You should watch for signs like fever, chills, or worsening symptoms and consult your doctor if they occur.


Could my medications be causing my diarrhea, nausea, and fatigue?

Yes, medications like Metformin and Humira can cause side effects such as diarrhea, nausea, and fatigue. It's important to discuss these symptoms with your doctor to see if any adjustments to your medication regimen are needed.


What are the potential implications of a swollen lymph node in my condition?

A swollen lymph node can indicate an infection or an inflammatory response. Given your symptoms and medication use, it's important to have it evaluated by a healthcare provider to rule out serious conditions and determine the appropriate treatment.

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