Brief Answer:
The chances are that you are suffering from OSTEOARTHRITIS.

Detailed Answer:
Hi!

If you've not had some blood work to include a CBC w/differential and some basic chemistries along with an ESR, CRP, FT4, TSH, RF, Lupus Anticoagulant, and ANA Panel (Quantitative and Qualitative) then, I would suggest getting your PA or whomever to order them for you.

Just to be very sure that you do not have some form of rather atypical autoimmune disorder that is just starting up.

I would also order a URINALYSIS looking for an occult or subclinical urinary tract infection since you are a diabetic and in an age range where such infections may exist very much UNDER THE RADAR as it were.

And I've seen where infections such as a simple UTI has caused some strange and sometimes inexplicable pains about the body which when treated result in such pains going away.

I've seen the same thing happen with people who are Vitamin D DEFICIENT and so would throw that into your testing batch.

If you've NOT had any X-rays taken of at least 1 of your most painful joints that you speak of with these problems then, I would also get a 2 or 3 view set of films.

I don't think a CT scan is necessary since CT emits about 200x the radiation that plain X-rays produce in order to see whether you are suffering an osteoarthritic condition or something else.

Certainly, if the X-ray is suspicious for anything more than routine in nature then, more sophisticated imaging such as CT, Ultrasound, MRI, or even arthroscopy could be employed.

I am VERY TENTATIVE to hear you receive what sound to be cortisone shots on anything more than an OCCASIONAL BASIS. I do not recommend you get these shots for 2 reasons:

Reason 1. You are diabetic and steroid injections given more than VERY OCCASIONALLY when absolutely necessary (and I don't frankly believe there are ABSOLUTELY necessary cases for this form of pain management with other options available such as AQUATHERAPY, THERMOTHERAPY, TENS THERAPY, NEUROTHERAPY, TMS THERAPY).

It will push your blood sugars out of control and cause you to be in an unwanted hyperglycemic state for days to weeks at a time.

The benefit from these shots clearly outweighs the risks in my opinion and whoever's opinion it is for you to get these shots should be spoken to, for the purpose of making sure they are carefully and frequently monitoring your glycemic status.

For that get HbA1C levels checked at least 1-2x/2-4 weeks, to be sure that those numbers are not unacceptably above your baseline WITHOUT the steroid shots.

Reason 2. Even the OCCASIONAL use of steroids into joints such as knees, hands, backs, and hips has been shown to cause toxic deteriorative effects to cartilage, tendons, ligaments, and muscle.

This eventually leads to a loss of their tensile strength and weakens them so that as supportive structures they will lose their stabilizing effects of joints and skeletal elements such as long and even non-long bones (carpals and tarsals in the hands and feet).

This is a vicious circle that theoretically can INCREASE PAIN since the stress factor on the skeletal structure as well as the articulations will increase in time.

So the more the shots the given the more pain can be produced indirectly.

Please do not be afraid to have this discussion with your provider.

Because they should really check with you first to see if it is your opinion that the pain relief which is temporary and quite possible not even complete is worth the risks of worsening your diabetes and sending you into events that can actually lead you to MORE PAIN.

This is precisely the reason you're getting the shots in the first place. Sounds like a self defeating regimen to me.

Check out the website of the XXXXXXX ARTHRITIS FOUNDATION for very good suggestions on EXERCISES (Aquatherapy, Land Therapy, Kinesiotherapy), DIETS which are believed to contribute to more positive outcomes in osteoarthritic degenerative processes, and then, when necessary the latest and more acceptable treatments for OSTEOARTHRITIS.

The medications I've had most success with in my patients include Ibuprofen and Diclofenac (pills and more recently topical liquid form which can be applied to the overlying skin of the knees, elbows, small joints of the hants, ankles, etc.).

There are also patches of Diclofenac that cover a much larger area and can be combined with things such as Acetaminophen or even neuropathic medications such as Gabapentin which can have some limited utility treating OSTEOARTHRITIC pains when used as an adjunct to the more standard NSAID regimens.

Hope I have answered your query.

Take care,
Dr. Dariush Saghafi, Neurologist

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