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Ask Dr. Arun Phophalia Your Own Question
Dr. Arun Phophalia
Dr. Arun Phophalia, Doctor
Category: Medical
Satisfied Customers: 56921
Experience:  MBBS MS. Post doctoral fellowship in Sports Medicine. General surgeon and sports medicine specialist
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I need to speak to a rheumatologist, yes but the waiting

Customer Question

I need to speak to a rheumatologist
JA: Have you seen a doctor about this yet? What medications are you taking?
Customer: yes but the waiting list to be seen by rheumotology is 18 weeks Currently taking naproxen and paracetamol
JA: Is there anything else the Doctor should know before I connect you? Rest assured that they'll be able to help you.
Customer: how much does this service cost?
JA: The Expert's answer will cost $10 to $100, depending on the issue type and time to respond. You'll see the exact amount on the next page and can decide then. It's way less expensive and more convenient than any face-to-face visit.
Customer: im in the UK , can I still use this?
Submitted: 21 days ago.
Category: Medical
Expert:  Dr. Arun Phophalia replied 21 days ago.

Welcome to Just Answer.
Answers here are for education and information.
I will respond shortly with an answer or further information request.

Expert:  Dr. Arun Phophalia replied 21 days ago.

What are your age and gender?

What are your symptoms?

What are the investigations and treatments done?

Customer: replied 21 days ago.
More background on my situation: I've been presenting with plantar fasciitis pain for the last 3 years. X-rays and ultrasound have confirmed the presence of plantar fasciitis and fluid in the area. However, on two occasions I have developed dactilytis of the toes. I currently have a swollen fifth toe and joint. The area is warm and tender and I can't bend my pinky toe. It's very stiff in the morning and I can only do so many activities during a day. I'm pretty sure this is psoriatic arthritis as is asymetrical and my mum has psoriasis. I've had blood work done a few years back and it wasn't able to pick up any inflammatory markers. My most recent symptoms the swollen pinky toe and redness and tenderness of the joint have been present for 8 weeks - starting to also get twinges in my knee. Physiotherapy for the PF seems to have been ineffective. I'm female and 26 years old
Expert:  Dr. Arun Phophalia replied 21 days ago.

Thanks for the further information.

I am writing the answer for you and will get back to you in 5 minutes.

Unless you wish to speak in person, you can ignore the request for a phone call automatically generated by the website, not by me.

Thank you.

Customer: replied 21 days ago.
Thanks - can you please advise if there are any other tests that I can seek out or medications I can take prior to a diagnosis of PSA or in the absence of?
Expert:  Dr. Arun Phophalia replied 21 days ago.

The inflammatory markers many times are not raised initially and thus need to be repeated. You would need the following;

1) HLA B 27.

2) X-rays and MRI of the sacroiliac joint and lumbar spine.

These two are cardinal to diagnose spondyloarthropathy/psoriatic arthritis.

You would also need the following;

a) Sedimentation rate.

b) Serum uric acid

c) RA factor

d) Antinuclear antibodies.

MRI of the foot also is advised.

The steroid shot in the toe is likely to help. Plantar fasciitis can be managed by;

1) Moist heat or ice compresses; whatever suits you

2) Anti-inflammatory analgesics like Ibuprofen

3) Local analgesic ointment /spray

4) Physical therapy

5) Deep electrotherapy like iontophoresis, phonophoresis, short wave diathermy, electrical stimulation, etc.

6) Consideration of steroid shot

7) Shock wave therapy

8) Custom-fabricated inserts

There is a new therapy called autologous blood injection in which your own blood is injected at the pain site, which is said to be quite effective. Shock wave therapy is available in sport medicine clinics or physical therapy clinics. This too is supposed to help in the resistant cases.

I wish your symptoms resolve soon.

I would be happy to assist you further if you need any more information.
Thanks for using Just Answer.

Customer: replied 21 days ago.
Thanks so much for this advice. I will show this to my GP to request for these tests to be carried out.
Expert:  Dr. Arun Phophalia replied 21 days ago.

You are very welcome.

Wishing you a speedy resolution and all the very best in life.

It was a pleasure to assist you.

I sincerely hope that I have helped you and that I have earned my 5-star rating today!

Thank you.

Stay blessed.