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Dr. D. Love
Dr. D. Love, Doctor
Category: Medical
Satisfied Customers: 18427
Experience:  Family Physician for 10 years; Hospital Medical Director for 10 years.
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I've had swollen, hot and painful joints years, I've

Resolved Question:

Hi, I've had swollen, hot and painful joints for 3 years, I've had blood tests and scans but all have come back as normal. I'm in constant pain and it's starting to affect my quality of life. I've also got alopecia, excess on the soles of my feet and thick, ridged nails. I've been to see my doctor again today but all blood tests normal again, inflammatory markers were 1? I don't know where to turn and I'm getting more confused as to what is causing it. The joints affected are my toes, feet, ankles, knees, wrists, hands and fingers, thanks
Submitted: 2 years ago.
Category: Medical
Expert:  Dr. D. Love replied 2 years ago.
Hello from JustAnswer.
Which anti-inflammatory tablets are you taking, including strength and frequency?
How long ago was the course of steroids?
Have you seen a Rheumatologist?
Customer: replied 2 years ago.
I'm taking naproxen 250mg, 2 twice a day. The last time I had steroids was about 18months ago from rheumatologist but as my tests were all clear she discharged me, to be honest I felt that they weren't taking me seriously from the start.
Expert:  Dr. D. Love replied 2 years ago.
Thank you for the additional information.

There are several issues to consider in this situation.

When there is chronic arthritis that has negative lab tests and imaging studies, the most common cause is osteoarthritis. Over time, there are changes from osteoarthritis that can be seen on imaging studies, but the imaging studies may be normal for some time initially.

A complete evaluation typically requires a consultation with a Rheumatologist, so it is generally good that you were seen by a Rheumatologist. However, if you feel that the Rheumatologist did not take you seriously and did not perform a thorough evaluation, it would be reasonable to consider another consultation with a different Rheumatologist.

If it has been 18 months since the course of steroids, another course of steroids would be a good option. There are many potential side effects that can occur with chronic or frequent use of steroids, but there is a much lower incidence of side effects when steroids are only used occasionally. Steroid injections into a joint that has persistent inflammation also is an option, but when a large number of joints are involved, this is not practical and oral steroids is a better option. Short courses of steroids can be used every 3-6 months without incurring significant risk of side effects.

For long term treatment, we prefer the use of non-steroidal anti-inflammatory drugs, such as the Naproxen. The Naproxen may do better at maintaining control after a short course of steroids gets better control of the inflammation. However, if the Naproxen is still not helping, the first issue is consideration of whether a higher dose is reasonable, and then there should be consideration of using a drug in a different chemical class. The dose of Naproxen that you are taking is appropriate, so it may be better to change to an anti-inflammatory in a different chemical class, such as diclofenac or piroxicam.

If I can provide any further information, please let me know.
Customer: replied 2 years ago.
Sorry for the delay in replying, does osteoarthritis affect multiple joints? I was really active and fit before all this and my joint pain happened over night, I woke up with stiff hands and within days all the joints I've mentioned were inflamed. I've read a couple of articles about sero negative inflammatory arthritis and wonder if it could be one of them. I also have alopecia, small areas of psoriasis in my head, thickened and ridged finger nails and strange blisters that come up on the soles of my feet and I'm wondering if it's all connected?
Expert:  Dr. D. Love replied 2 years ago.
Yes, osteoarthritis frequently can affect multiple joints.

Yes, a sero-negative inflammatory arthritis is also a possibility, and the usual mechanism for diagnosis of sero-negative inflammatory arthritis is by an examination by a Rheumatologist. This is why an evalaution by a Rheumatologist is an important step in the evaluation of people with these symptoms.

There is a type of arthritis that is associated with psoriasis, which is called psoriatic arthritis, but again, it is the evaluation by a Rheumatologist that is the usual mechanism for diagnosis of psoriatic arthritis.
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