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Forum Name: Rheumatology Topics

Question: rheumatology consult pending


 iMarzz - Fri Apr 27, 2007 6:48 pm

I am a 50 year old female.

PMHx: Graves' Disease, Atrial Flutter, keratoconjunctivitis sicca, IBS

PSHx: C-section following ruptured uteris, B/L Hernia repair in infancy

Significant family history: Grandfather - arthritis ? type. Died age 53 ARF; grandmother - hypothyroidism (her sister had Graves' Disease) and ITP; Sister ankylosing spondylosis

Current Medications: Mobic, Lyrica, Keflex, Ultram

In August at age 49 began to have pain in both knees at rest. Knees began to swell with intense pain and stiffness at first in am and after rest which progressed to all the time, including awakening at night. Knees collapsed at the end of november. Was placed on Lodine.

MRI L knee: torn meniscus, effusion, OA, soft tissue edema
MRI R knee: torn meniscus, joint effusion, mild OA

Had Cortisone injections in knees B/L with moderate relief.
Developed Baker's Cyst behind R knee.

Around that time began to have pain in B/L shoulders and elbows. R > L.

WBC 12.1 Neutrophils 8.8
Lyme negative
ANA 20 negative
RA factor 4.7 negative
ESR 4
C-Reactive protein 4.2 Negative

Continued to have unrelieved pain, morning stiffness and stiffness after rest. Pain increases in knees after prolonged use also. Poor sleep, waking because of pain primarily now elbows and shoulders. AM stiffness and mild pain in feet, and pain after prolonged use.

Returned to PMD when left arm swelling noted above dorsal side of L wrist, pain in both wrists and numbness, tingling and burning sensation. Pain with driving and writing. Also occassional tingling in feet at rest. Diagnosed with Carpal Tunnel Syndrome. Placed on present meds and wrist braces at night, with improved relief and referred to rheumatologist. ESR now 10, negative.

Also experienced peripheral neuropathy with Thyrotoxicosis 10 years ago and on and off since. TSH pending.

Any thoughts?
 iMarzz - Tue May 08, 2007 11:15 am

Sorry, I'm not on keflex I'm on zanaflex.

Since no one has responded i'll let you know how the consult goes it's not until May 30, that's why I was looking for a kind of preview. Anyway it seems they are looking for rheumatoid arthritis.
 iMarzz - Thu May 31, 2007 12:47 pm

Hi All,

Just an update I have been diagnosed by the rheumatologist with seronegative inflammatory arthritis. Got a steroid shot in the foot, and was started on Prednisone 30, 25, 20, 15, and then 10 mg daily until my next appt in 2 weeks.

Says it's RA since I don't have psoriasis or crohn's disease.

Can anyone tell me what to expect next? Is prednisone usually given long term. I don't really think I want to take it for very long. Is it just for acute flares and then maybe Methotrexate? I've heard it is very hard to get off prednisone once it is started because the swelling returns.

Anyone with any experience with newly diagnosed RA, I would love if you could tell me anything you can. Or any MD's/ RN's out there I hope you will respond.

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