RA?

Question  I am a 38 year old female with fibromyalgia managed w/ rest, yoga, Cataflam (50 mg bid) and Celexa. One year ago I developed asymmetric joint & soft tissue pain, swelling & redness that was preceded by a GI infection. I also exhibited a low grade fever that would spike 2 times a day up to 101-102. The fever, pain & stiffness were unbearable. My family MD prescribed prednisone which helped immensely & sent me to a gastro to rule out Crohn's. One month later my scope & biopsy returned no findings of Crohn's. I was then referred to a rheumatologist to rule out reactive arthritis/AS. It took 2 months to see him & my symptoms had almost completely subsided by then. According to him, my tests were not indicative of a rheumatic process, HLA-B27 was negative & no involvement of the SI joints. He basically shrugged his shoulders, looked at me like I was crazy and gave a generic diagnosis of "poly-arthralgia". He said it may have been reactive arthritis, but since my HLA-B27 was negative, it appeared to have resolved spontaneously & would likely not return. Now one year later, my fever, joint pain & swelling have returned in similar asymmetric pattern to previously affected & new joints. I recently moved across country, have a new family MD who has my history & records but is re-doing all tests and "watching to see what happens". Meanwhile I am miserable and feel like my bad dream is back. What should I do? I do not want this to progress to how it was a year ago. Could I have RA or reactive? Any insight you could offer would be greatly appreciated. Thank you.
 
Answer  Unfortunately, in this game, no one can diagnose what he or she doesn't see and thus I can't blame your prior rheumatologist for not making the diagnosis. It sounds like you may have a reactive arthritis and hopefully you'll be able to see a rheumatologist when you have swollen joints for him or her to evaluate.

Last update: 03:49 PM Tuesday, April 24, 2007

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Author:

Alan Matsumoto, M.D.

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