Question: I am 46 M, other wise healthy and no medical issues. However, I am facing this joint paint issue since about 40 days. It started within a few days of long run (about 8 km), so i thought this must be some muscular pain which will subside by itself, but this did not happen. It started on both the knees, due to which it became difficult to drive, and finally i had to stop driving. Now there is also stiffing on both wrists when I get up in morning, this is mild and fades away. Also minor flares in hip and back. I am very concerned as to what is happening. All tests, like RA factor, anti ccp, hla have come out negative. One ortho doctor i met last week suggested me to take 10 mg of methotrexate, twice a week, and 8 mg of medrol, for twice a week, and 200MG hcqs FOR 3 WEEKS. Another Rheumatologist suggested me to take one 80 mg depomedrol injection. I am really confused whether i should take oral or go for injection. i think 80 mg injection is too high, the rheumatologist doctor did not even go through my clinical history in detail. I wish to inform that for nearly 4-5 months before this happening, i am facing with bowel problems, diaorhea, however since there was no pain i ignored. could there be a link. all stool exames have come clear, after i took some deworming tablets. please advice as the pain is in new joints almost every day.

dear dr XXXXXXX
appreciate your reply.
do you suggest i shd get colonoscopy done. Will this be for bacterial infections, or checking any damage to colon linings etc. yes, the stools were loose. Can it also be infection of the stomach or you suspect it is probably colon.

Is depomedrol injection having same effect as the oral, or is it better. Is the injection painful

ESR was 28 initially, after 3 weeks it was 8. This is after I took some dose of medrol and methoxytrate. please inform i can send you reports

Dear Dr XXXXXXX thanks indeed really appreciate, vitamin d3 is 120nmol per L, B12 is 261, calcium ok, no swelling

DEAR DR XXXXXXX

As I informed you in preceeding email, all values for calcium (total, ionic), vitamin d3 (hydroxy) and vitamin b12 are in normal ranges. vitamin b12 is 261 pg/ml , (bio ref interval is 211-911).

I wish to inform you that the medrol/methotrexate were recommended by ortho surgeon. The rheumatologist who i met suggested a depomedrol injection. I am confused.

So yesterday, I took opinion of a another rheumatologist (~reputed one at XXXXXXX ram), and I was asked to wait for 2 weeks, before next exam and he prescribed me "pregabid", calcium supplements (which i am already taking- like triple a cal), vitmin d3 (60IU per week), which i am also taking, and physiotherapy. So this was not of any help, I have done research and This tablet pregabid is meant for neuropathy pains and not arthritis. He informed that there is still no swelling in any joints, although I told him that pain in both knees is such that I am having difficulty walking. Further I don't think it is neural pain due to nerve impingement. The cracking sound on both my knees has increased quite a bit, in course of last month. The X Ray says, mild reduction in joint spaces in medial compartment of tbiofemoral joint. Sub articular sclerosis is seen. spiking of tibial spines is seen. Petellofemoral joints are normal. Doctor informs there is no major conculsion from X=RAY, it is normal at my age.

Now please suggest,

whether I should take medrol/methotrexate tablets, which there be any neg impact.

should i take depomedrol injection

or, I should take pregabid (which i think is not a proper medicine for my case).

thank at lot.

Dear Dr XXXXXXX
I must thank you for your reply, which has given me a much better degree of clarity, as I was frankly confused after meeting so many doctors, and I do-not want the “trial and error approach”, which seem to be the path suggested by doctors, unless I am very sure of the clinic diagnosis of doctors and reasons, thereof.
Please advice.
1)     After how many days is generally swelling observed in RA. I am facing this knee pain for nearly 50 days now, and seems there is no swelling. However, the cracking sound in both my knees has definitely increased, since the time problem started. After sitting in chair in office for a while, if I try to extend the knees, I can clearly hear this cracking sound at the joint. Is this due to some inflammation in joint, or ligaments or minicus/cartilage, or muscle. I am facing small degree of pain after this cracking sound.
2)     Also the pain in my knees has increased. However some days I feel better, and pain is much less. At the higher level of pain, it becomes difficult to climb or stand for long. Though When it is better, I can climb and walk longer. This really surprises me.
3)     Further pain is also there in other joints like lower back, hips, some times a flare in neck region. Yesterday, I was surprised to have a slight pain in chest region, when I never had all this before, it subsided after a short while, though, (~2-3 minutes)
4)     Also the moment I get into sleep, I can see the stiffness progressing in both my wrists region. This disturbs my sleep, and due to pain flares and stiffness, I have to get up at night, although I am generally a sound sleeper, 7-8 hours sleep daily.
5)     I want to know whether I am facing Fibromylagia, as pregabid is generally prescribed for this ailment. Or I am facing ankolysing arthritis/spondylosis, or RA. Does pregabid has any side affects, as I was asked to take it for 15 days, till I see the doctor next
6)     Please advice so I can commence right treatment path.
Still there is no swelling in any joint region, however pain is there in number of joints, predominantly in knee area. I am concerned if I donot take any medication soon, will it deform the joint, or I should wait and watch, and bear the pain.

Dear Dr XXXXXXX
Thanks once again, a very prompt reply. I will wait, as adviced by you until any further symptoms flare up, I am also meeting a rheumatologist (~ a very XXXXXXX one who prescribed me prebabid) in next few days and will keep you posted if concerns arise. Do you think I should start pregabid-15 days dose, daily 50 mg or wait?

Meanwhile, I am worried about knee sound (crepitus), as this is painful. without pain i wont worry.

Do you suggest any medicines (~like glucosomine etc) or exercise to reduce crepitus, or eliminate. I can feel knee grinding when I put my hands on the knee, so i am concerned if this is eventually wearing down the cartilage or the meniscus.

thanks a lot, once again. 5 stars to you for all the help, and so prompty


Also, to add I never had this crepitus before. It had only started about 50 days ago, when this pain episode started in both the knees, and i had to completely give up driving. So why has this started in the first place??