[70M] With multiple symptoms including dry eyes and joint pain

Patient Description

A 70-year-old male presents with itchy, gritty eyes with a burning sensation for the past 6 months, alleviated somewhat by eye lubricating drops. He also reports dry eyes and a very dry mouth. Joint pain, described as dull and mild, affects the elbows and right shoulder and has persisted for several years. Additional symptoms include itching on the face and scalp, exacerbated by wearing a hat, fatigue, and nausea, particularly on an empty stomach, for several months. Visual disturbances include seeing white spots after jogging and complementary color afterimages in bright light, which began about 6 months ago. He experiences sinus pain with phlegm, dull tooth pain in the upper molars, and Raynaud’s phenomenon in cold weather. A 10-day course of doxycycline provided slight improvement in symptoms. His medical history includes hypothyroidism, myocardial infarction with stent placement, and calcium oxalate renal stones. He takes levothyroxine, Crestor, valsartan, metoprolol, tamsulosin, aspirin, and omeprazole daily, and has an allergy to ACE inhibitors. He also takes vitamins and acetyl L-carnitine with alpha-lipoic acid. Concerns about Sjögren's syndrome are noted, though previous tests for rheumatoid factor, ESR, and CRP were negative.

Arora's Assessment

What might be happening

Your symptoms could be related to several conditions:

Sjögren's Syndrome: This autoimmune disorder can cause dry eyes, dry mouth, joint pain, and fatigue. It might explain your dry eyes and mouth, as well as your joint pain and fatigue. Testing for specific antibodies (like SSA/Ro and SSB/La) can help diagnose this condition.
Chronic Sinusitis: Your sinus pain and phlegm, along with tooth pain, could be due to chronic sinusitis. This condition can cause facial pain and pressure, and sometimes antibiotics are needed for treatment.
Medication Side Effects: Some of your symptoms, like muscle or joint pain, could be related to Crestor (a statin). Discussing this with your doctor might be helpful.
Visual Disturbances: Photopsia and afterimages can be related to eye strain or other eye conditions. An eye exam might be necessary to rule out any serious issues.

What you can do

For Dry Eyes and Mouth:

Continue using lubricating eye drops.
Stay hydrated and consider using a humidifier at home.
Chew sugar-free gum or suck on sugar-free candies to stimulate saliva production.

For Joint Pain:

Gentle exercises and stretching can help maintain joint flexibility.
Over-the-counter pain relievers like ibuprofen may help, but consult your doctor first.

For Sinus Pain:

Use saline nasal sprays or rinses to help clear your sinuses.
Consider using a warm compress on your face to relieve sinus pressure.

For Visual Disturbances:

Rest your eyes regularly, especially if you spend a lot of time on screens.
Schedule an eye exam to rule out any underlying issues.

General Health:

Keep a symptom journal using MDandMe to track your symptoms and share with your healthcare provider.
Follow up with your doctor to discuss your symptoms and any necessary tests or treatments.