Have Symmetrical Arm, Shoulder And Leg Aches. Developed Itchiness In Thighs And Ankles. What To Do?

Posted on Wed, 16 Oct 2013

Question: I have written several times as you can see . I am still in the dark as to my problem. But let me present it again. About 8 months ago I started having symmetrical arm, shoulder and leg aches. Not severe, but achy. I would also get fatigue. Tremors were also a symptom. I have been to neurologists, GPs, endrocrinologist, etc. I have had normal MRI, myriad blood tests for Lupus, rheumatic problems, thyroid, etc. They have all come back normal. I've even been to a nauralpathic doc who checked me for heavy metals etc. I did have some low amplitude arm results on one of the three EMGs I have had, but neuro said it was not significant.. My Neuro doc says its not MS, polymyalgia rheumatica, or ALS. My symptoms seem to stay much longer than before but are not debilitating save for the fatigue. All my aches migrate from arms, to forearms, to shoulders, to thighs etc and wax and wane. I have also developed itchiness in the thighs and ankles and sometimes in the hands. My glucose is never over 114 fasting and A1c never above 5.6 fasting. I have been told it could be CFS or Fibromyalgia, but the tremors and symmetrical aches as well as itchiness don't fit with those. I'm running out of options so I'd appreciate any other ideas you may have.

Answered by Dr. K. Naga Ravi Prasad (1 hour later)

Brief Answer:
May be side effects of Medicines.

Detailed Answer:
Hi, thanks for writing to XXXXXXX

As all types of clinical examination by various specialist doctors turned out to be normal and the investigations do not show up any abnormality, I suspect that your symptoms are due to the side effects of the drugs you are consuming.

Muscle weakness, Muscle fatigue & aches and tingling sensations are some of the adverse reactions of LOTENSIN (Benezepril) usage. Also, benezepril causes Hyperkalemia (increase in blood potassium levels) which contributes to most of the muscle pains.

Itching is one of the adverse reactions with the use of PROPRANOLOL.

So, I suggest you to consult your treating physician either for a change of dosings in the medications or change to a new drug for your Hypertension.

Please follow the below mentioned links to see more side effects of the medicines

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Hope I have addressed your query.

Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. K. Naga Ravi Prasad (15 hours later)

Your answers are plausible. However, I have been taking lotensin for years with no adverse effect. I started taking propranolol about a year ago when I began to develop what was diagnosed as an essential tremor. I thought my symptoms mirrored MS, but a XXXXXXX 2012 MRI showed no evidence of that. I also saw an orthopedic doc about two years ago and he said I had some stenosis. My docs did a second MRI on the spine and said that was not my problem either.

This problem has gotten worse and worse. It no longer waxes and wanes but stays pretty much all the time. If I exert any muscle group I get extremely fatigued and achy. It also seems to affect my balance. I had a blood test in April 2013 which showed my potassium at 4.2. I was told I had CFS 20 years ago and that perhaps it was back, but these symptoms don't seem to mirror CFS or fibromyalgia either.

Perhaps this further information will help you provide me with a solution. thanks so much

Answered by Dr. K. Naga Ravi Prasad (7 hours later)

Brief Answer:
I still feel that Lotensin is the culprit.

Detailed Answer:
Hi, Nice to hear from you.

As you have been taking Lotensin since many years, the possibility of suffering its adverse effects is much more. While all other examinations and investigations could not detect a possible cause of your symptoms, I think it is rationale to point out that Lotensin is the culprit (as majority of your symptoms are established side effects of the drug).

The other possibility to be considered is CFS. To XXXXXXX the diagnostic criteria of CFS, you must be having unexplained persistent fatigue for more than 6 months along with atleast 4 of the following signs & symptoms -
* Loss of memory or concentration
* Sore throat
* Enlarged lymph nodes in your neck or armpits
* Unexplained muscle pain
* Pain that moves from one joint to another without swelling or redness
* Headache of a new type, pattern or severity
* Unrefreshing sleep
* Extreme exhaustion lasting more than 24 hours after physical or mental exercise

The rarest but established cause of muscle weakness is Vitamin D deficiency. So,I suggest you to get Vitamin D blood estimations to see if there is any deficiency.

Hope I have justified your query. Good day

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. K. Naga Ravi Prasad (2 hours later)

I don't have the traditional CFS symptoms that I had years ago. I was thinking more of the propranolol, I started taking it year ago to help with tremors. Primidone made me feel terrible so I started on propranolol. Additionally, a couple of drinks of alcohol seems to help with the symptoms to a degree. I will speak to my primary doc about changing from Lotensin and propranolol to something else.

Answered by Dr. K. Naga Ravi Prasad (10 minutes later)

Brief Answer:
That's a better idea.

Detailed Answer:
Hi, It's a better idea to change both the medications and let us see if it works and your sympoms wane off.

As I said earlier, get your Vitamin D levels checked once as Vitamin D deficiency also produces vague muscle aches & fatigue.

Polymyalgia rheumatica is one more condition where muscle pains will be prominent. The most important diagnostic biochemical parameter is an increased ESR (erythrocyte sedimentation rate). This condition responds well to Predisolone.

Have a great day

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. K. Naga Ravi Prasad (10 hours later)

thanks, vitamin D levels are fine, and as I noted in the first post I have had blood test for many, many ailments including Polymyalgia rheumatica. Sed rate and CK were good.

Muscle relaxants do nothing, but Alcohol helps.

Answered by Dr. K. Naga Ravi Prasad (27 minutes later)

Brief Answer:
Hope you will find an answer soon.

Detailed Answer:
Hi, Nice to hear from you.

I wish that you will find an answer for your symptoms sooner.

Just because Alcohol is helping you, don't rely too much on it.

Good luck

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. K. Naga Ravi Prasad (4 hours later)

A final question. Since my itching is migratory and I have other symptoms of MS, would it be useful to have another MRI? The one I had that my neuro doc looked at was 13 months before I had any of my current symptoms. Does MS show up months or years earlier on a brain MRI? thanks

Answered by Dr. K. Naga Ravi Prasad (4 hours later)

Brief Answer:
MRI of brain is NOT THE ONLY Diagnostic tool

Detailed Answer:
Hi, This is just to let you know that Multiple sclerosis cannot be confirmed only by MRI of brain. Because like in MS, Myelin loss in brain is also seen in Migraine and Diabetes.

So, a series of investigations like CSF examination by Lumbar puncture and Evoked potential tests are also needed to confirm the presence of Multiple sclerosis.

Well, the most common early sign of MS is OPTIC NEURITIS, which manifests clinically in the form of Visual disturbances (blurring of vision or loss of vision in one or both eyes)

Yes, You can have an MRI scan to know the presence of Demyelination either in the brain or spinal cord. But, I am not certain whether early signs of demyelination will be picked up by MRI before clinical sympoms manifest. Hopefully, not.

Have a great day.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. K. Naga Ravi Prasad (25 minutes later)

about 4 months ago I also had a spinal MRI which showed no evidence of MS. Should I stop looking in that direction and concentrate on CFS and change of medicine? thanks

Answered by Dr. K. Naga Ravi Prasad (1 hour later)

Brief Answer:
Multiple Sclerosis is unlikely in your case.

Detailed Answer:
Hi, that's right. Forget about MS for the time being and think of the other two remaining possibilities (CFS & Medications change) which may pave you the way for a possible cause of your symptoms.

Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. K. Naga Ravi Prasad (12 hours later)

I find that my vision varies on a day to day basis. It is not horrible but it definitely does fluctuate. If I feel better my vision is better. I am wondering if this is a symptom of CFS? Also, should I consider Fibromyalgia?

Answered by Dr. K. Naga Ravi Prasad (18 minutes later)

Brief Answer:
Get an Opthalmologist appointment.

Detailed Answer:
Hi, I suggest you to consult an Opthalmologist for a detailed examination and to rule out the presence of Optic neuritis which excludes MS. Also, to look for any abnormalities in the ocular surface and reduced accommodation for age (two most common clinical findings in CFS)

CFS and Fibromyalgia are most often confused with one another in diagnosing them as Fatigue is the hallmark of both the conditions. One important differentiating aspect with regard to fatigue is that - in CFS, the debilitating fatigue occurs at the cellular level whereas the fatigue of Fibromyalgia is more likely associated with underlying insomnia, depression, and chronic pain.

Hope I have given you a clarity of thought.

Regards

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar