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Dr. Stan
Dr. Stan, Medical Physician and Surgeon
Category: Medical
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Experience:  Johns Hopkins Fellowship Trained, Certified and Licensed Medical Physician and Surgeon
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I have a client that when she turned 50, she started to fall

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I have a client that when she turned 50, she "started to fall apart" She developed accute Carpal Tunnel Syndrome. She complains of joint pain and fatigue. I've visibly noticed her ankles, wrists and elbows are puffy, almost like localized sacs of fluid. Also, her hands are calussed and dry which is something she never had prior. Any ideas what could be going on?

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It is likely that she is experiencing the symptoms and complications of an autoimmune connective tissue or collagen vascular condition, such as rheumatoid arthritis, polymyositis, Scleroderma, Lupus, or thyroid disorder, among others. The specific condition can be determined following a closer evaluation with tests including ANA, ESR, C-reactive protein, dsDNA, Anti-Sm antibody, Anti-SSA (rho), Anti-SSB (La), TFTs, Anti-Scl-70 and ANCA panels. In general, these autoimmune conditions can be complicated with carpel tunnel syndrome, and do respond positively to prednisone treatment. However, the use of prednisone should be temporary and/or at a very low dose if longer term use is desired, due to the side effects of water retention and increase blood glucose level, cataract, increase eye pressure and/or blood pressure. Often other disease modifying agents such as methotrexate, cyclosporine, azathioprine, or infliximab can be added or used solely to control the progression of the condition. The specific drug to be used depends on her response, the results of the tests, and her doctor's determination. I suggest that she follow-up with her doctor for the above considerations.

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