Hello,
Thank you for posting your query at DoctorSpring.com
You have elaborated your symptoms quite well, I have few suggestions, livedo reticularis documented, neurological symptoms which are varied and in different part is not territorial to dermatome or blood supply with new onset arthralgias, can happen in many rheumatic conditions.
What about fatigue?
weight loss?
Fever?
Swelling of any joints?
VISION ABNORMALITY?
Any picture suggestive of joint swelling with comparative picture of normal uninvolved site.
Hair loss,oral ulcer,oral dryness, early morning stiffness etc.
any acute phase reports like ESR, CRP? If done provide details about the same.
THYROID FUNCTION TEST, VIT D STATUS, VIT B12 STATUS, COMPLETE BLOOD COUNT AND ANY CHANGE FROM PAST, ANA if done. I need the reports of all of these for a conclusive diagnosis.
Regards,
Dr. Pandey
Patient replied :
Hello Dr Pandey,
Thanks you for your response. In aswer to your questions:
What about fatigue? Slight weight loss? Slight Fever? No, but continual sinus issues - blocked or runny nose with loss of smell and taste. Swelling of any joints? Not exactly although an area just below right ankle (the one that aches) is puffy - I will try to take a pic for visual comparison. VISION ABNORMALITY? No
Hair loss? As a 42 yr old male I have a degree of Male Pattern Baldness I take finasteride daily to manage it - have not noticed a noteable increase in shedding. Oral ulcer? Yes about 6 weeks ago - never had one before either. Treated with Bonjella and Anti Flam mouth wash Oral dryness? Yes, mild Early morning stiffness etc. Slight - mainly noticeable in ankles and feet - stiffness and pain.
Bloods: ESR, CRP, Thyroid, Full count etc? I had a full set of bloods including ESR & CRP done back in mid January - results normal at the time. I have just had another full set done and will be getting the results shortly and let you know.
ANA, VIT D STATUS, VIT B12 STATUS - I have not had these done as GP would request only off the back of other abnormal bloods. Although I very much doubt I have any Vit defeciencies.
One last thing to mention is that when the rash flares up as it has just done - on the underside of my forearms as livedo and on the back of my hands as a reddness, it comes with a burning sensation on the skin and causes those areas to feel inflamed in the muscles.
Hope this is useful.
Thanks,
Alex
Dear Alex I will try I simple expression about a disease in evolution. The classical example would be rheumatoid arthritis in evolution were most of the reports will be negative that is ESR CRP etc. the other expression is highly positive arthritis factor like CCP or RF but no disease manifestation. The dilemma is labeling a disease in evolution where it's best guess whether disease is going to regress naturally or progress and which test to order which can be covered under an insurance policy or state policy. In India, I have the liberty to individualize the investigation policy and I would have done an ultrasound of swollen joint and document the site and intensity of inflammatory change if any. I would like pictures of livedo reticularis lesion, joint involved, well this photos would also make your GP understand the changes over a period of time. Please update with pictures if any. Regards