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Forum Name: Rheumatology Topics

Question: Multiple joint pain and pitting edema


 mandaspanda - Sun Nov 01, 2009 3:18 pm


I've been experiencing joint pain in multiple joints for the last four months and for the last two days, I've also had pitting edema in my lower legs. I'm baffled.

My medical history is:

Born at 35 weeks gestation with slightly premature lungs. Had ear infections off and on the entire first year. Tubes were put in my ears at 15mos. Ear infections continued until around age 12. From ages 8-14, I had bronchitis or pneumonia every spring and winter. Menses began at age 12. By 13, my cycles were painful. At 14, I had an ovarian cyst on my left ovary. From ages 14-18 I suffered with depression. I left home after graduating from high school at 17 and went to college. At 18, I was diagnosed with spina bifida occulta- my spine failed to fuse at the S1 level. (That explains the sciatica and lower back pain!) I married a soldier at 19, and gave birth to our first son the following year. The pregnancy was unremarkable until the 36th week when I went in for a routine appointment. My blood pressure was 163/97 and I had a 3+ protein on dipstick. Stress test was fine, but they decided to induce labor immediately and started mag. This was to become the norm for my pregnancies. After this little one was born, with magnesium poisoning, premature lung disease, and congenital pneumonia, with the aid of forceps, I decided no more kids! That lasted two years, at which time I was diagnosed with secondary infertility due to insulin resistant diabetes not pcos. After three months on metformin, I was able to concieve. This time around, the high blood pressure and protein began in the 33rd week. Labor was held off until the 37th week. Perfect baby, great labor. Two years later, baby three came along. Preeclampsia began in the 35th week, but due to a lapse in healthcare (military hospital), baby wasn't born until 39 weeks. Perfect baby. No magnesium this time around. Seven months later, severe stomach pains began. Labs were normal. CT scan showed fluid in the abdomen. Nothing was diagnosed or further explored. The following year, baby four came along. The high blood pressure began in the early second trimester. A rise in protein was also noted through "routine" 24hr urines done every three weeks. I decided to seek civilian care, feeling this pregnancy warranted good healthcare. I got lucky and had the military perinatologist (who had retired) I'd had with the two previous pregnancies, and an amazing OB. At 27 weeks, my 24hr urine came back over 400. We began steroids in preparation of baby's imminent arrival. BUT my bp dropped as long as I was resting, so I was allowed to go home on strict bed rest. No further 24hr urines were ordered. Labor was induced at 37 weeks and baby was born with vacuume assistance. BP returned to normal within two weeks. I spoke with my OB about my painful periods and he said it was probably endometriosis, but only by doing surgery would he be able to give a diagnosis. He also said that he and my peri were doubting it was actually preeclampsia but some underlying condition that was popping up due to the stress of pregnancy. Unfortunately, my time with him was up and I returned to military health care. That leads us to when THIS stuff began. (=

Nine months after my last little one was born, I woke up with a sore left knee. It was slightly swollen. Thinking I'd slept funny, I ignored it for two days. When it didn't get better, I was referred to an "over-flow doctor" as my regular clinic was full. X-rays showed fluid but no joint damage. That evening, my right knee started hurting and swelling. By the following week, other joints were affected. Right shoulder, then left shoulder. Left hand, right hand. Left ankle, right ankle. Hips. Even my toes- the big ones and the little ones, but the ones in the middle escaped this stuff. I returned to the doctor only one week after the joint pain began. RA was his thinking and wanted to begin steroids, but I was breastfeeding, so he said motrin, tylenol, and heat for the pain, cold for the swelling. He also ordered lab tests. I followed up with my assigned primary care doctor who had the same thought. She ordered lab tests. In both sets of tests, my sed rate was slightly elevated. All else was normal/negative. Other sets of xrays were done on my shoulders, feet, and hands- fluid free. I was sent to a rheumatologist. He said it could be early RA, said to try mobic 2x/day, and said to follow up in 3mos or sooner if any of my major joints swelled up 2-3x their normal size, but that hand swelling was normal and not medically important. That appointment was a 6 weeks ago. I tried the mobic for a week, but switched back to my motrin/tylenol regime as it works better for the joint pain and the menustral pain. Two days ago, I noticed my lower legs were swollen. I smooshed them and realized it was pitting edema! I've only had that when pregnant. I have an appointment with a GYN nurse next week, but I'm wondering if I should schedule an appointment with my primary care provider for this asap or if it could wait a bit. What could be causing this? The potential RA? What tests should I ask for?

Thanks in advance for all your insight and information. I feel it's necessary for me to become informed and proactive in my quest for adequate healthcare.
 Dr.M.jagesh kamath - Mon Sep 06, 2010 11:08 am

User avatar Hello,Your case might fit in with a syndrome which is benign with complete resolution in 10 to 15 months of onset.
REMITTING SERONEGATIVE SYMMETRICAL SYNOVITIS WITH PITTING OEDEMA IN YOUNG ADULTS: A SUBSET OF RHEUMATOID ARTHRITIS OR A DISTINCT SYNDROME?
M. A. SATTAR
Department of Medicine, Faculty of Medicine, Kuwait University P. O. Box 24923 Safat, 13110 Safat, Kuwait (Arabian Gulf)
1990 British Society for Rheumatology Oxford Journals Medicine RheumatologyVolume 29, Number 6Pp. 479-481.
RA factors were negative and there was no radiographic evidence of erosions in these cases.
Hope this information is useful.
My good wishes.

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