[49F] Experiencing severe joint pain and stiffness

Patient Description

A 49-year-old female presents with severe joint pain in her hands, hips, feet, and elbow, accompanied by fatigue, numbness, and tingling in her hands and feet. She experiences stiffness that persists throughout the day, particularly severe upon waking and lasting for a few hours, with some relief from heat and light activity. The joint pain, described as sharp and aching, has been present for 3 years and is sometimes severe enough to disrupt sleep. She reports her big toe feeling as though it is being 'ripped off.' Her hands are frequently swollen, sometimes all day, with some joints appearing red and warm to the touch, and a sensation akin to a rubber band around her finger. She has also noticed joint deformities and experiences limb weakness and night sweats. She has a history of Raynaud's diagnosed in her late twenties. She is currently taking methylphenidate approximately four times a week (36mg) and daily supplements of Omega 3 and biotin, with dosages unspecified. There is no known family medical history due to lack of information on her mother's or father's side, no known allergies or adverse reactions to medications, and she does not smoke.

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Arora's Assessment

What might be happening

Based on the symptoms you've described, here are some possible conditions that could be causing your symptoms:

  • Rheumatoid Arthritis (RA): This is an autoimmune disease that causes chronic inflammation of the joints. It often starts in smaller joints, like those in the hands and feet, and can cause joint pain, stiffness (especially in the morning), swelling, redness, and warmth. Over time, RA can cause joint deformities. Fatigue is also a common symptom. Your Raynaud's disease is often associated with autoimmune conditions like RA.

    • Diagnosis typically involves blood tests for certain antibodies and imaging tests like X-rays. Treatment usually involves medications to reduce inflammation and slow the disease's progression.
  • Psoriatic Arthritis: This is a type of arthritis that affects some people with psoriasis, a condition that features red patches of skin topped with silvery scales. Most people develop psoriasis first and are later diagnosed with psoriatic arthritis, but the joint problems can sometimes begin before skin patches appear. Joint pain, stiffness and swelling are the main symptoms of psoriatic arthritis.

    • Diagnosis typically involves physical examination, blood tests, and imaging tests. Treatment usually involves medications to reduce inflammation and slow the disease's progression.
  • Lupus: This is an autoimmune disease that can affect many different body systems, including your joints, skin, kidneys, blood cells, brain, heart and lungs. Lupus can be difficult to diagnose because its signs and symptoms often mimic those of other ailments.

    • Diagnosis typically involves blood tests for certain antibodies and imaging tests. Treatment usually involves medications to reduce inflammation and manage symptoms.

Please note that these are only possibilities and not a definitive diagnosis. It's important to consult with a healthcare provider for an accurate diagnosis.

What you can do

  1. Schedule an appointment with your primary care provider or a rheumatologist. They can perform a physical exam and order the necessary tests to determine the cause of your symptoms.
  2. Keep a symptom diary. Note when your symptoms occur, how long they last, and any potential triggers. This can be helpful information for your healthcare provider.
  3. Try gentle exercises like yoga or swimming. These can help keep your joints flexible without putting too much stress on them.
  4. Apply heat to stiff joints and muscles. You can use a warm towel, take a warm bath or shower, or use a heated blanket.
  5. Try over-the-counter pain relievers like acetaminophen (Tylenol) or nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil, Motrin) or naproxen (Aleve). Always follow the package instructions.

What you should look out for

Seek immediate medical attention if:

  • Your joint pain and swelling become severe or unbearable
  • You develop a fever, as this could indicate an infection
  • You notice a new rash, as this could be a sign of an autoimmune disease like lupus
  • You experience sudden weight loss, as this could be a sign of a serious underlying condition.

Remember, it's important to consult with a healthcare provider for an accurate diagnosis and treatment.

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10 mo ago

People Also Ask


What are the common symptoms of rheumatoid arthritis?

Common symptoms of rheumatoid arthritis include joint pain, stiffness (especially in the morning), swelling, redness, warmth, fatigue, and over time, joint deformities. It often starts in smaller joints like those in the hands and feet.


How is psoriatic arthritis different from rheumatoid arthritis?

Psoriatic arthritis is associated with psoriasis and can cause joint pain, stiffness, and swelling. Unlike rheumatoid arthritis, it may also involve skin symptoms like red patches with silvery scales. Psoriatic arthritis can affect any joint and may cause different patterns of joint involvement.


What are the typical diagnostic tests for lupus?

Typical diagnostic tests for lupus include blood tests to check for specific antibodies, such as antinuclear antibodies (ANA), and imaging tests to assess organ involvement. A physical examination and review of symptoms are also crucial for diagnosis.


Can lifestyle changes help manage joint pain and stiffness?

Yes, lifestyle changes can help manage joint pain and stiffness. Gentle exercises like yoga or swimming can maintain joint flexibility. Applying heat to stiff joints, maintaining a healthy diet, and using over-the-counter pain relievers can also provide relief.


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