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Suggest Treatment For Severe Back And Leg Pain Caused By Arthritis
Question: Hi Dr XXXXXXX
The question this time is related to my sister. She is in pain since January this year. Pain started at the back and the leg and continues now in all her body specially the arthritis (hands, legs and shoulders) and severe pain in the back.
We have done the MRI (attached) on the back and went to many orthopaedic doctors who prescribed all different medicines in the market related to the muscle relaxation, neural, and pain relief and nothing worked. Actually she was getting more pain with these medications.She also has Swollen ankle and foot and sometimes hands. We have done efferent kind of analysis including vitamins, RF, CRP, ERS, Uric acid, ASOT, Calcium, ANA, XXXXXXX and others (all attached) which is denoting low calcium level and high ESR and CRP. So, we went to Endocrinologist doctor who requested analysis for 25 OH V (Vitamin D) along with PTH. Analysis showed deficient D with high PTH which explained why Clacium is low and why she is having pain in her bones as PTH is taking calcium from the bones to increase the blood calcium level. So the doctor decided to increase here vitamin D level by injecting D3 500,000 IU ampules once per month. She took two now, one in Last May and the other one was a week ago. He also prescribed Osteocare once daily to increase blood calcium level. When she took the first ampule, she started to feel better and she was OK for two weeks and then she has a setback again as if nothing happened. We thought if she took the second ampule she might get better again but unfortunately same pain. I thought there might be something with the Kedney since she has this swollen ankle and foot and we did Creatinine, Blood Urea, and Urine analysis (attached) but the analysis was so good which indecates that the kedney is functioning well. We advised her to drink a lot of water since she was not drinking enough and now the swollen foot and ankels are somehow getting better. But the pain is still sever in all here body bones in her arthritis, shoulder, XXXXXXX with special pain in her backbone. No pain relief is working with her at all, panadol extra, cataflam, mobic, any nonsteroidal anti-inflammatory drug, nothing is working.
We need your advice on what exactly the case is, what should we do further, what can stop this pain, etc.
Your prompt response is really appreciated.
Thanks,
xxxxxxxxxxx
The question this time is related to my sister. She is in pain since January this year. Pain started at the back and the leg and continues now in all her body specially the arthritis (hands, legs and shoulders) and severe pain in the back.
We have done the MRI (attached) on the back and went to many orthopaedic doctors who prescribed all different medicines in the market related to the muscle relaxation, neural, and pain relief and nothing worked. Actually she was getting more pain with these medications.She also has Swollen ankle and foot and sometimes hands. We have done efferent kind of analysis including vitamins, RF, CRP, ERS, Uric acid, ASOT, Calcium, ANA, XXXXXXX and others (all attached) which is denoting low calcium level and high ESR and CRP. So, we went to Endocrinologist doctor who requested analysis for 25 OH V (Vitamin D) along with PTH. Analysis showed deficient D with high PTH which explained why Clacium is low and why she is having pain in her bones as PTH is taking calcium from the bones to increase the blood calcium level. So the doctor decided to increase here vitamin D level by injecting D3 500,000 IU ampules once per month. She took two now, one in Last May and the other one was a week ago. He also prescribed Osteocare once daily to increase blood calcium level. When she took the first ampule, she started to feel better and she was OK for two weeks and then she has a setback again as if nothing happened. We thought if she took the second ampule she might get better again but unfortunately same pain. I thought there might be something with the Kedney since she has this swollen ankle and foot and we did Creatinine, Blood Urea, and Urine analysis (attached) but the analysis was so good which indecates that the kedney is functioning well. We advised her to drink a lot of water since she was not drinking enough and now the swollen foot and ankels are somehow getting better. But the pain is still sever in all here body bones in her arthritis, shoulder, XXXXXXX with special pain in her backbone. No pain relief is working with her at all, panadol extra, cataflam, mobic, any nonsteroidal anti-inflammatory drug, nothing is working.
We need your advice on what exactly the case is, what should we do further, what can stop this pain, etc.
Your prompt response is really appreciated.
Thanks,
xxxxxxxxxxx
Brief Answer:
Polyarthritis likely.
Detailed Answer:
Hello,
Thanks for posting your query.
In your sister's case, the persistent pain in the joints with raised CRP and ESR is suggestive of an inflammation. The pain all over the body can be due to low vitamin D3 levels but pain in the joints is likely to be due to rheumatoid arthritis. Other causes like low thyroid hormone levels also need to be ruled out.
Arthritis requires expert care with various disease modifying drugs (Imunomodulators). She can start these drugs after discussing with her doctor. Consulting a rheumatologist will help.
I would like to give some diet tips which might be helpful to get rid of these pain. Often the elimination of certain foods such as the following will help greatly:
Dairy products, with the exception of plain yogurt with active culture
Citrus, with the exception of lemon and grapefruit
Alcohol
Meat including beef, pork, and lamb (other sources of protein such as chicken, fish and beans are less likely to promote inflammation)
Vegetable oils (continue using olive oil and the essential fatty acids flax seed, sesame, pumpkin, sunflower oils)
I would also like to give some advice to make the life better and to fight with these pains-
Do regular physiotherapy of joints.
Hot fomentation to decrease the joint stiffness
Hot bath of Epsom salts (magnesium sulphate)-Magnesium has both anti-inflammatory and anti- arthritic properties and it can be absorbed through the skin.
I hope this answers your query.
In case you have additional questions or doubts, you can forward them to me, and I shall be glad to help you out.
Wishing you good health.
Regards.
Dr. Praveen Tayal.
For future query, you can directly approach me through my profile URL http://bit.ly/Dr-Praveen-Tayal
Polyarthritis likely.
Detailed Answer:
Hello,
Thanks for posting your query.
In your sister's case, the persistent pain in the joints with raised CRP and ESR is suggestive of an inflammation. The pain all over the body can be due to low vitamin D3 levels but pain in the joints is likely to be due to rheumatoid arthritis. Other causes like low thyroid hormone levels also need to be ruled out.
Arthritis requires expert care with various disease modifying drugs (Imunomodulators). She can start these drugs after discussing with her doctor. Consulting a rheumatologist will help.
I would like to give some diet tips which might be helpful to get rid of these pain. Often the elimination of certain foods such as the following will help greatly:
Dairy products, with the exception of plain yogurt with active culture
Citrus, with the exception of lemon and grapefruit
Alcohol
Meat including beef, pork, and lamb (other sources of protein such as chicken, fish and beans are less likely to promote inflammation)
Vegetable oils (continue using olive oil and the essential fatty acids flax seed, sesame, pumpkin, sunflower oils)
I would also like to give some advice to make the life better and to fight with these pains-
Do regular physiotherapy of joints.
Hot fomentation to decrease the joint stiffness
Hot bath of Epsom salts (magnesium sulphate)-Magnesium has both anti-inflammatory and anti- arthritic properties and it can be absorbed through the skin.
I hope this answers your query.
In case you have additional questions or doubts, you can forward them to me, and I shall be glad to help you out.
Wishing you good health.
Regards.
Dr. Praveen Tayal.
For future query, you can directly approach me through my profile URL http://bit.ly/Dr-Praveen-Tayal
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thanks doctor,
1. If this is rheumatoid arthritis, why the RF analysis is normal?
2. If RF is not accurate to diagnose rheumatoid arthritis, what analysis can accurately do?
3. Do we need blood test to rule out the low thyroid hormone levels? if so, what are the tests? T4, TSH, what?
4. Why does she need Immunomodulators when the ANA blood test is negative?
5. What is the explanation for her feeling better when she took the first 500,000 IU Vit D3 ampule for two weeks even she was eating all the same food you have described above (actually she was drinking a lot of milk at this time to increase calcium)?
1. If this is rheumatoid arthritis, why the RF analysis is normal?
2. If RF is not accurate to diagnose rheumatoid arthritis, what analysis can accurately do?
3. Do we need blood test to rule out the low thyroid hormone levels? if so, what are the tests? T4, TSH, what?
4. Why does she need Immunomodulators when the ANA blood test is negative?
5. What is the explanation for her feeling better when she took the first 500,000 IU Vit D3 ampule for two weeks even she was eating all the same food you have described above (actually she was drinking a lot of milk at this time to increase calcium)?
Brief Answer:
Details below.
Detailed Answer:
Hello.
Thanks for writing again.
1. In rheumatoid arthritis, RA factor can be normal. That is a seronegative type of arthritis.
2. Anti CCP antibodies is another test for rheumatoid arthritis. But it is mainly a clinical diagnosis based on symptoms.
3. Yes She needs blood tests like T3, T4 and TSH for this.
4. Immunomodulators are the first line treatment of rheumatoid arthritis. There are many other kinds of antibodies also except ANA. ANA rules out other disorders like SLE.
5. Vitamin D3 supplement improved her fatigue and one of the deficiencies. So she felt like she recovered partially. After the generalized fatigue decreased the joint pains became more prominent. The pain in rheumatoid arthritis can increase and decrease depending on multiple factors.
Hope my answer is helpful.
Do accept my answer in case there are no further queries.
Regards.
Details below.
Detailed Answer:
Hello.
Thanks for writing again.
1. In rheumatoid arthritis, RA factor can be normal. That is a seronegative type of arthritis.
2. Anti CCP antibodies is another test for rheumatoid arthritis. But it is mainly a clinical diagnosis based on symptoms.
3. Yes She needs blood tests like T3, T4 and TSH for this.
4. Immunomodulators are the first line treatment of rheumatoid arthritis. There are many other kinds of antibodies also except ANA. ANA rules out other disorders like SLE.
5. Vitamin D3 supplement improved her fatigue and one of the deficiencies. So she felt like she recovered partially. After the generalized fatigue decreased the joint pains became more prominent. The pain in rheumatoid arthritis can increase and decrease depending on multiple factors.
Hope my answer is helpful.
Do accept my answer in case there are no further queries.
Regards.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
1. "Anti CCP antibodies is another test for rheumatoid arthritis. But it is mainly a clinical diagnosis based on symptoms."
Don't understand this. Is it only the symptoms that can diagnose RA or Anti CCP can do? can the anti CCP accurately diagnose the case as RA? if not, what is the best and most accurate test that can diagnose the case for sure and "without doubt" that this is RA or not?
I think you agree with me that this is a dangerous disease and we have to be 100% sure.
2. If it's RA, can she recover or she will have to suffer the whole of her life and all what we can do is just to contain the disease? If she can recover fully, what is the expected time frame?
3. Is the Immunomodulators effective in treating this disease or it just minimize the consequences and progression? what other drugs are effective in dealing with this case?
Don't understand this. Is it only the symptoms that can diagnose RA or Anti CCP can do? can the anti CCP accurately diagnose the case as RA? if not, what is the best and most accurate test that can diagnose the case for sure and "without doubt" that this is RA or not?
I think you agree with me that this is a dangerous disease and we have to be 100% sure.
2. If it's RA, can she recover or she will have to suffer the whole of her life and all what we can do is just to contain the disease? If she can recover fully, what is the expected time frame?
3. Is the Immunomodulators effective in treating this disease or it just minimize the consequences and progression? what other drugs are effective in dealing with this case?
Brief Answer:
Details below.
Detailed Answer:
1. Anti CCP antibodies helps in diagnosis in 80% of cases. There is no test that can diagnose it more accurately. We cannot be 100% sure of the diagnosis. Rest 20% diagnosis depends on the clinical symptoms evaluated by a rheumatologist. It is difficult to get 100% accuracy in medicine as all humans are different and exceptions are always there.
2. We can contain the disease with the help of medicines but there can be intermittent flare ups at any time.
3. Immunomodulators minimize the disease progression and give relief symptomatically. It also decreases the flare ups. There is no absolute treatment with one cure forever.
Regards.
Details below.
Detailed Answer:
1. Anti CCP antibodies helps in diagnosis in 80% of cases. There is no test that can diagnose it more accurately. We cannot be 100% sure of the diagnosis. Rest 20% diagnosis depends on the clinical symptoms evaluated by a rheumatologist. It is difficult to get 100% accuracy in medicine as all humans are different and exceptions are always there.
2. We can contain the disease with the help of medicines but there can be intermittent flare ups at any time.
3. Immunomodulators minimize the disease progression and give relief symptomatically. It also decreases the flare ups. There is no absolute treatment with one cure forever.
Regards.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
She did the Anti CCP today and the result was OK. The report is attached.
What do you think?
What do you think?
Brief Answer:
Do get her clinically evaluated by a Rheumatologist.
Detailed Answer:
Hi
I have seen the report. The Anti CCP antibodies are not raised. The chances of having a rheumatoid arthritis are less but it is best to get her clinically evaluated by a Rheumatologist for further treatment.
Regards.
Do get her clinically evaluated by a Rheumatologist.
Detailed Answer:
Hi
I have seen the report. The Anti CCP antibodies are not raised. The chances of having a rheumatoid arthritis are less but it is best to get her clinically evaluated by a Rheumatologist for further treatment.
Regards.
Above answer was peer-reviewed by :
Dr. Arnab Banerjee
not sure if this is an RA case!
Question: from what you see in the MRI report along with the symptoms, could it be a Polyneuritis case? if so, does it cause the raise in the ESR and CRP, swollen foot and ankle, pain in shoulders and backbone, and pain in carpal? should we consult a neurologist?
Question: from what you see in the MRI report along with the symptoms, could it be a Polyneuritis case? if so, does it cause the raise in the ESR and CRP, swollen foot and ankle, pain in shoulders and backbone, and pain in carpal? should we consult a neurologist?
Brief Answer:
Neurologist is not likely to help you much.
Detailed Answer:
The MRI report suggests just a minor disc bulge. It is not likely to cause a significant nerve compression. Polyneuritis is associated with generalized pains with numbness, tingling and burning sensations. The pain in your sister's case is more localized around the joints. Hot compress provides a temporary relief. It is more likely to be a musculoskeletal issue- can be myalgia, myositis or polyarthritis.
Consulting a rheumatologist and endocrinologist will be a better option.
Regards.
Neurologist is not likely to help you much.
Detailed Answer:
The MRI report suggests just a minor disc bulge. It is not likely to cause a significant nerve compression. Polyneuritis is associated with generalized pains with numbness, tingling and burning sensations. The pain in your sister's case is more localized around the joints. Hot compress provides a temporary relief. It is more likely to be a musculoskeletal issue- can be myalgia, myositis or polyarthritis.
Consulting a rheumatologist and endocrinologist will be a better option.
Regards.
Note: For further follow up on related General & Family Physician Click here.
Above answer was peer-reviewed by :
Dr. Nagamani Ng
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