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I am having bilateral pain in both hands, joints in palm…

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I am having bilateral pain...
I am having bilateral pain in both hands, joints in palm area. Swelling, no redness, no heat but very stiff, it's challenging to type, ring out a cloth, opening water bottle, anything with Deterity. MY hands ache!! All day. Began 3 weeks ago, although I have had this off and on, started after birth of my son, when he was a few weeks old. Was just tested for inflammation but doctor says ok, previously tested for RH factor and ana but negative. That was approx 5-6 years ago. I am healthy but tired, I have some pain in my knees, that is new...I do run. I ran recently and my shoulders ached terribly!!! sometimes I have pain in my elbow but it doesn't last. I am 54, no medical history except hypertension treated with OLmetec 20mg. I have no known allergies, recently tested as I had a rash on my face for 5 weeks, was checked for food allergies and there was none identified. I do not smoke, I am normal weight, I am physically active. I have had psoriasis in my hairline. I have raynaulds.
Family history, stroke, MI, grandfather had RA, my son has spondylosis and spondylithesis, vitiligo, eczema, psoriasis, my youngest son has alopecia. So since blood work ok, what next? Can I test negative but have arthritis. I have no overt signs of joint changes. What other condition could be causing this?
Submitted: 8 months ago.Category: Medical
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Answered in 28 minutes by:
9/20/2017
Doctor: Dr. Bob, Medical Doctor replied 8 months ago
Dr. Bob
Dr. Bob, Medical Doctor
Category: Medical
Satisfied Customers: 5,679
Experience: 20 Years in Internal Medicine, Neurology and Sports Medicine
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Hi there. It sounds very much like an auto-immune or auto-inflammatory condition, and your personal and family medical histories would support this. There are a few possibilities here. One is that the level of inflammation is high enough for you to feel it, but too low to be detected by blood tests. Antibody levels can vary, for example, from day to day, or even within a single day. Your prior blood tests may have been done at "the wrong time" so to speak, and they should be repeated.

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Doctor: Dr. Bob, Medical Doctor replied 8 months ago

Another possibility is that you have a "seronegative" spondyloarthritis, in which symptoms (and inflammation) are present but current blood tests are normal. This reflects the reality that our understanding of immunology is still limited, and has a way to go. Patients like this are still managed by rheumatologists and typically are treated in a similar fashion to those who do test positive.

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Doctor: Dr. Bob, Medical Doctor replied 8 months ago

One possible approach to your situation would be a trial of prednisone, a powerful anti-inflammatory. In some cases that don't follow the textbooks, we will give a patient a "burst" of prednisone (eg. 5 days) to see if symptoms improve. In some cases, the improvement is dramatic and this not only helps the patient feel better, but helps to confirm the diagnosis of an autoimmune condition. Some doctors do not feel comfortable doing this, but we have had good success with it. I would suggest you see an academic rheumatologist (one who works at a medical school) as they are the specialists most likely to be up to date on the latest tests and therapeutic maneuvers. The sooner you get your diagnosis pinned down, the sooner you can start a treatment (or management) plan and the better idea you will have of what to expect in the future.

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Doctor: Dr. Bob, Medical Doctor replied 7 months ago

Hello? Do you have any follow up questions? If so, let me know and I would be happy to help further.

If not, a positive rating would me much appreciated. This is the only way physician-experts on this site get compensated for the time they spend helping patients.

Best wishes,

Doctor-Bob

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Customer reply replied 7 months ago
Hi Dr Bob, thank you for your detailed answer. My hands remain stiff, painful, now the balls of my feet. I am seeing my doctor tomorrow and will ask for a rheumatology consult, I hope she will agree to one.
Doctor: Dr. Bob, Medical Doctor replied 7 months ago

I think that will be helpful. Hope all works out for the best for you.

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Customer reply replied 7 months ago
Hello again, quick question, my doctor did not refer me to Rheumatologist as she felt my inflammations markers were not high enough, I was 10 and she said at 14 is when she would refer, she did however send me to get both hands xrayed to see if any joint damage and if there is, she agreed she would do referral to Rheumalogist. Would joint damage be evident in early stages? I sure hope there would not be joint damage.
My hands remain very stiff, that is almost daily and is bilateral, so are my feet but feet only on awakening, but the other joint aches, such as elbow is just one side and comes and goes.
Thank you!
Doctor: Dr. Bob, Medical Doctor replied 7 months ago

This is a reasonable approach. The more serious arthritides such as RA, lupus, psoriatic arthritis are often erosive, meaning the joints show characteristic features of degeneration and bone loss. This might not be apparent in the earliest stage, but certainly would indicate, if present, a more severe disease process that would need to be managed more aggressively. In the meantime, these arthridites often respond well, though temporarily, to anti-inflammatories.

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