[54F] With lower back pain and morning ankle stiffness
Patient Description
A 54-year-old female presents with lower back pain that began three weeks ago, described as stabbing pain exacerbated by sitting, standing up from sitting, and bending forward. The pain is rated as 7 out of 10 at its worst and 4 out of 10 on a daily basis. The patient has been managing the pain with 600mg of Ibuprofen and a heating pad. Additionally, the patient reports stiffness and sharp pain in the left ankle every morning for the past month, which improves with movement. The pain is rated as 8 out of 10 when first waking up and putting weight on the ankle. There is no swelling, redness, or warmth in the ankle. The patient has a history of psoriatic arthritis and multiple sclerosis (MS), diagnosed in 2019, and has experienced lower back problems for many years, usually presenting as a burning pain on the left side. The patient is not currently taking any prescribed medications for psoriatic arthritis. The patient has experienced a recurrence of psoriasis, with random spots on the arms and legs and flaking on the knees. The patient is allergic to penicillin and is currently taking medications for PVC, amlodipine besylate, rosuvastatin, citalopram, and a water pill, all on a daily basis. The patient also takes 600mg of Ibuprofen every 6 hours.
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Arora's Assessment
What might be happening
It is likely that your symptoms are related to multiple issues, including existing diagnoses. If you have more questions, we can continue chatting.
Lower Back Pain
- Muscle Strain or Ligament Sprain: Given the sudden onset of stabbing pain without any trauma, it could be due to muscle strain or ligament sprain. These are common causes of lower back pain and can be exacerbated by movements like sitting, standing up, and bending forward.
- Degenerative Disc Disease: Chronic lower back pain, especially with a burning sensation, could be due to degenerative disc disease, which is common as we age.
- Psoriatic Arthritis: Since you have a history of psoriatic arthritis, it could also be contributing to your lower back pain. Psoriatic arthritis can cause inflammation in the spine, leading to pain and stiffness.
Left Ankle Stiffness and Pain
- Psoriatic Arthritis: Given your history, psoriatic arthritis could be causing the stiffness and sharp pain in your left ankle. This condition can lead to joint inflammation and pain, especially in the morning or after periods of inactivity.
- Tendinitis or Bursitis: These conditions can cause sharp pain and stiffness in the ankle, especially after periods of rest.
Unifying Diagnoses
- Psoriatic Arthritis: This condition could explain both your lower back pain and your left ankle stiffness and pain. Psoriatic arthritis can affect multiple joints and cause inflammation, pain, and stiffness.
- Inflammatory Conditions: Given your history of multiple sclerosis (MS) and psoriatic arthritis, other inflammatory conditions could also be contributing to your symptoms.
What you can do
Lower Back Pain
- Consult a Doctor: It's important to see a healthcare provider to get a proper diagnosis and treatment plan. They may recommend imaging studies like X-rays or MRIs to better understand the cause of your pain.
- Pain Management: Continue using over-the-counter pain relievers like Ibuprofen, but be cautious about long-term use. Applying heat can help relax muscles and reduce pain.
- Physical Therapy: A physical therapist can provide exercises to strengthen your back muscles and improve flexibility, which can help alleviate pain.
- Posture and Ergonomics: Ensure that your sitting and standing posture is correct. Use ergonomic furniture to support your back.
Left Ankle Stiffness and Pain
- Consult a Doctor: Given the severity of your pain, it's important to see a healthcare provider. They may recommend imaging studies or refer you to a specialist.
- Pain Management: Continue using over-the-counter pain relievers like Ibuprofen. Applying ice to the ankle can help reduce inflammation and pain.
- Gentle Exercise: Gentle range-of-motion exercises can help improve flexibility and reduce stiffness. Avoid putting too much weight on the ankle until the pain subsides.
- Footwear: Wear supportive shoes that provide good arch support and cushioning.
General Tips
- Medication Adherence: Since you have a history of psoriatic arthritis, it's important to follow up with a rheumatologist to discuss potential treatments. Medications can help manage symptoms and prevent joint damage.
- Symptom Tracking: Use MDandMe to journal your symptoms, track progress, get insights, and share longitudinal medical notes with your provider. This can help your healthcare provider make informed decisions about your treatment.
What you should look out for
Given the severity of your symptoms and the possibility of underlying conditions, you should seek medical care as soon as you can. Reasons to seek care even more urgently include:
- Severe or Worsening Pain: If your pain becomes unbearable or significantly worsens.
- Numbness or Weakness: If you experience numbness, tingling, or weakness in your legs or feet.
- Changes in Bowel or Bladder Function: If you notice any changes in your bowel or bladder function, seek immediate medical attention.
- Swelling or Redness: If you notice swelling, redness, or warmth in your ankle, it could indicate an infection or other serious condition.
Remember, while I can provide information and suggestions, it's important to consult with a healthcare professional for a formal diagnosis and treatment plan.
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5 mo ago