Resolved question:
The day after Thanksgiving I woke up unable to move without help lain so hprrible I could not stand it in every large joint and muscle I am a 49 year old female Iin good health. I went to the E R initially they did a cardiac work up due to the pain everything was normal they sent me home with flexeril and pain meds. I went to my dr on Monday she sent me for labs said maybe a virus labs came back crp152 immunoglobulin m 305 ra factor 15 aldolase 12.5 cpk 7 all else norm she put me on prednisone 40 mg which I was on 5 weeks before ahe tapered me back sent me to a rheumotoligist he did labs crp down to 55 img m still at 305 all complimemts were good. They have no idea what is wrong with me at this point labs are better however I still have small joint pain I also developed 3 finger tips that would turn blue for no apparent reason and caused a great deal of pain especially at night this has gotten better but I am still so weak I am unable to work a full day any ideas. Scperaderma was neg parvo virus and limes disease were also neg. Any ideas
Submitted:
4 Days
Category:
Rheumatologist
Hello,
Thank you for choosing DoctorSpring.
I understand your concern and I know that could be really frustrating to not to have conclusive diagnosis even after this amount of investigations.
Considering the nature of onset of your symptoms - Sudden onset over few days, I would strongly consider a Post Viral arthralgia a strong diagnostic possibility. This is basically a joint pain caused by a viral infection. This might take weeks to months for a complete resolution. So you need to be patinet and wait for a resolution. Meanwhile you can take a NSAID pain medication. DO NOT over exert the joints. Steroids are not necessary.
It does not rule out a connective tissue disorder completely though : For a confirmed diagnsis you will require these additional investigations
1. ANA (by line immunoassay)
2. Lupus anti coagulant and anti cardiolipin antibodies
3. Basic blood panel. (if not done already).
Viral studies and immunoglobulin levels are of not much help. In a nutshell :
1. Most likely post viral arthralgia. Needs rest, pain medication
2. An undiagnosed connective tissue disorder (exacerbated by a viral infection) to be considered.
Hope this helps
Feel free to ask follwups.
Thank you
these are the latest labs hope this helps answer some questions my pain level is much better but i am so weak i can hardly function. this is very frustrating and i just dont feel good at all.
Date of Service Document Format
12/18/2013
12:14 PM
Attachment Original lab test results (12/23/2013 4:12:28 PM).pdf
.PDF
Lab Test Results
antineutrophil cytoplasmic ab
Test Low Normal High Reference Range Units
atypical panca <1:20 Neg:<1:20
perinuclear (p-anca) <1:20 Neg:<1:20
cytoplasmic (c-anca) <1:20 Neg:<1:20
antiscleroderma-70 antibodies
Test Low Normal High Reference Range Units
antiscleroderma-70 antibodies <0.2 0.0-0.9
cryoglobulin, ql, serum, rflx
Test Low Normal High Reference Range Units
cryoglobulin, ql, serum, rflx None Detected at 72 hours None detected
parvovirus b19, human, igg/igm
Test Low Normal High Reference Range Units
parvovirus b19, igm 0.2 0.0-0.8 index
parvovirus b19, igg 0.4 0.0-0.8 index
complement c4, serum
Test Low Normal High Reference Range Units
complement c4, serum 29 9-36 mg/dL Adult
aldolase
Test Low Normal High Reference Range Units
aldolase 12.7 1.2-7.6 U/L
complement c3, serum
Test Low Normal High Reference Range Units
complement c3, serum 164 90-180 mg/dL Adult
immunofixation, serum
Test Low Normal High Reference Range Units
immunoglobulin m, qn, serum 305 40-230 mg/dL
immunoglobulin a, qn, serum 164 91-414 mg/dL
immunoglobulin g, qn, serum 1027 700-1600 mg/dL
immunofixation result, serum An apparent polyclonal gammopathy: IgM. Kappa and lambda typing appear increased.
creatine kinase,total,serum
Test Low Normal High Reference Range Units
creatine kinase,total,serum 12 24-173 U/L
cholesterol, total
Test Low Normal High Reference Range Units
cholesterol, total 147 100-199 mg/dL
c-reactive protein, quant
Test Low Normal High Reference Range Units
c-reactive protein, quant 55.5 0.0-4.9 mg/L
vitamin d, 25-hydroxy
Test Low Normal High Reference Range Units
vitamin d, 25-hydroxy 21.0 30.0-100.0 ng/mL
Document Format
1/3/2014
11:57 AM
Attachment Original lab test results (1/6/2014 5:06:20 AM).pdf
.PDF
Lab Test Results
aldolase
Test Low Normal High Reference Range Units
aldolase 9.4 1.2-7.6 U/L
tsh
Test Low Normal High Reference Range Units
tsh 1.02 0.46-4.7 uIU/mL
cbc with differential/platelet
Test Low Normal High Reference Range Units
eos 1.0 0-5.5 %
basos 0.3 0-1.0 %
monocytes(absolute) 0.5 0.2-1.0 x10E3/uL
eos (absolute) 0.1 0-0.5 x10E3/uL
baso (absolute) 0.0 0-0.1 x10E3/uL
nrbc 0 0-0 %
neutrophils (absolute) 10.2 1.6-7.3 x10E3/uL
lymphs 17.4 16-48 %
platelets 231 150-450 x10E3/uL
rdw 14.4 11.3-16.0 %
mchc 33.3 32-36 g/dL
mch 31.8 28-35 pg
hematocrit 44.8 35-46 %
hemoglobin 14.9 12.0-16.2 g/dL
rbc 4.71 4.0-5.2 x10E6/uL
wbc 13.2 4.5-11.0 x10E3/uL
lymphs (absolute) 2.3 1.1-3.5 x10E3/uL
neutrophils 77.3 41-74 %
monocytes 4.0 3-12 %
mcv 95.2 80-98 fL
c-reactive protein, quant
Test Low Normal High Reference Range Units
c-reactive protein, quant 8.7 0.0-4.9 mg/L
comp. metabolic panel (14)
Test Low Normal High Reference Range Units
glucose, serum 88 65-110 mg/dL
bun 27 7-20 mg/dL
creatinine, serum 0.77 0.55-1.05 mg/dL
egfr if nonafricn am 80 >60 mL/min/1.73
egfr if africn am 97 mL/min/1.73
bun/creatinine ratio 35.0 1
sodium, serum 142 137-145 mmol/L
potassium, serum 3.6 3.6-5.0 mmol/L
chloride, serum 106 98-107 mmol/L
carbon dioxide, total 21 22-30 mmol/L
calcium, serum 9.3 8.4-10.2 mg/dL
protein, total, serum 6.4 6.3-8.2 g/dL
albumin, serum 3.4 3.5-5.0 g/dL
globulin, total 3.0 2.2-3.6 g/dL
a/g ratio 1.1 0.9-1.7 1
bilirubin, total 0.4 0.2-1.3 mg/dL
alkaline phosphatase, s 112 38-126 IU/L
ast (sgot) 13 15-46 IU/L
alt (sgpt) 30 11-66 IU/L
creatine kinase,total,serum
Test Low Normal High Reference Range Units
creatine kinase,total,serum < 20 30-135
sedimentation rate-westergren
Test Low Normal High Reference Range Units
sedimentation rate-westergren 7 0-15 mm/hr
Thank you
Undifferentiated connective disorder and post viral arthralgia still stands out as the possibilities after going through the investigations. Please follow my recommendation. You might want to patiently wait for some time. hopefully the symptoms will resolve by then. I would request you to get the test suggested after 12 weeks and if you happen to be in mosquito infested area Chikungunya serology ( a viral infection ) must be done.
Hope this helps
Feel free to ask followups
Thank you