[54F] Experiencing nocturnal chills with chronic pain and rheumatoid arthritis
Question
Which of the possibilities seems most relevant.
Patient Description
A 54-year-old female has been experiencing chills almost all night for the past three months, which come on gradually and are temporarily relieved by smoking a cigarette. The chills are triggered by being still in bed and chronic pain from rheumatoid arthritis. The patient has noticed more swelling in her joints recently. She has not experienced any fever, night sweats, or unexplained weight changes, but has noticed increased thirst and fatigue after smoking. Her weight has been fluctuating between 97 and 107 pounds. She is currently taking several medications, including Buspar (10 mg three times a day for 2 years), Lamictal (starting dose twice a day for 2 years), Cymbalta (90 mg a day for 4 years), Plaquenil (starting dose once a day), Tylenol (2000 mg a day), and Suboxone (2 mg twice a day). She also takes vitamin D and calcium supplements. The patient has a history of fibromyalgia, which has improved since starting Suboxone six months ago, and type 2 diabetes, which has been stable for 1 year. She has several allergies, including penicillin, amoxicillin, Keflex, iodine, medical tape, and nickel. Additionally, she has a duodenal diverticulum near the pancreas, which is non-operable, and has undergone 10 joint replacement surgeries and fusion of cervical vertebrae C3 to C7 due to spinal stenosis. Her joint pain, which has been present since she was 9 years old due to juvenile rheumatoid arthritis and continuing adult rheumatoid arthritis, varies in severity throughout the day, being worst in the mornings. Suboxone, warm rooms, and hot showers help to relieve her joint pain. The patient has discussed her smoking habits with her healthcare provider, who mentioned that smoking makes healing take longer. Despite trying to quit smoking five times, she has not been successful. She has also been on opiates and Prednisone for many years to manage her rheumatoid arthritis and chronic pain.
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Arora's Assessment
What might be happening
It sounds like you have a complex medical history with multiple conditions that could be contributing to your symptoms. Here are some possible explanations:
Chills and Temperature Fluctuations
- Rheumatoid Arthritis (RA): RA can cause systemic symptoms like chills and temperature fluctuations due to inflammation. The fact that you feel cold at night despite a warm environment could be related to your RA.
- Medication Side Effects: Some of the medications you are taking, such as Cymbalta and Plaquenil, can cause temperature regulation issues as side effects.
- Smoking: Smoking can affect your circulation and body temperature regulation, which might explain why you feel hot after smoking a cigarette.
Increased Joint Swelling and Pain
- Rheumatoid Arthritis Flare-Up: The increased swelling and pain in your joints could be due to a flare-up of your RA, especially since you recently stopped taking Humira, which was helping to control your symptoms.
- Fibromyalgia: Although you mentioned that your fibromyalgia symptoms have decreased since starting Suboxone, it can still contribute to overall pain and discomfort.
Increased Thirst and Weight Fluctuations
- Diabetes: Even though your blood sugar levels are currently normal, diabetes can still cause increased thirst. Weight fluctuations could be related to changes in your diet, activity level, or fluid retention due to RA.
General Health Decline
- Post-COVID-19 Effects: Many people experience lingering symptoms and a general decline in health after recovering from COVID-19, which could be contributing to your overall feeling of unwellness.
What you can do
Chills and Temperature Fluctuations
- Consult Your Doctor: It's important to discuss these symptoms with your healthcare provider to rule out any serious underlying conditions and to adjust your medications if necessary.
- Stay Warm: Continue using your heated blanket and consider wearing layers to bed to help manage your body temperature.
- Limit Smoking: Reducing or quitting smoking can improve your circulation and overall health, which might help with temperature regulation.
Increased Joint Swelling and Pain
- Consult Your Rheumatologist: Given the recent increase in swelling and pain, it's crucial to consult your rheumatologist. They may need to adjust your treatment plan or consider alternative medications.
- Pain Management: Continue using warm rooms and hot showers to relieve pain. Over-the-counter pain relievers like Tylenol can also help, but be sure to follow dosing recommendations.
- Physical Activity: Gentle exercises and stretching can help maintain joint function and reduce stiffness.
Increased Thirst and Weight Fluctuations
- Monitor Blood Sugar: Keep an eye on your blood sugar levels, even if they are currently normal. Regular monitoring can help you catch any changes early.
- Stay Hydrated: Drink plenty of water to stay hydrated, especially if you are experiencing increased thirst.
- Balanced Diet: Maintain a balanced diet to help manage your weight and overall health.
General Health Decline
- Post-COVID-19 Care: Discuss your lingering symptoms with your healthcare provider. They may recommend specific treatments or lifestyle changes to help you recover.
- Healthy Lifestyle: Continue to focus on a healthy lifestyle, including a balanced diet, regular exercise, and adequate sleep.
What you should look out for
Given the complexity of your medical history and the severity of some of your symptoms, it's important to seek medical care if you experience any of the following:
- Severe or Sudden Symptoms: If you experience severe pain, sudden swelling, or any new or worsening symptoms, seek medical attention immediately.
- Signs of Infection: Watch for signs of infection, such as fever, redness, or warmth around your joints, especially since you have a history of RA and have recently stopped taking Humira.
- Heart Symptoms: Given your history of a mild heart attack, be vigilant for any signs of heart problems, such as chest pain, shortness of breath, or unusual fatigue.
Remember, while I can provide information and suggestions, it's important to consult with your healthcare provider for a formal diagnosis and treatment plan. You can also use MDandMe to journal your symptoms, track your progress, get insights, and share longitudinal medical notes with your provider.
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