Sign-in to Ask A Doctor - 24x7
OR
Sign in with Google
Suggest Treatment For Pain And Morning Stiffness In The Hands And Feet
Question: I've been diagnosed with RA and fibro for about 5 years. My first dr treated the fibro only because I didn't have swelling of joints. I had a positive RA bloodwork and severe pain in hands and feet After a few years he abruptly left his practice and the country not that it matters. My new rhematologist after X-rays ultra sounds me labs said what my pcp said originally RA. But doesn't treat fibro I'm on methotrexate now 12 weeks. Each week I worsen my joints. Hurt so much. Now it feels like my muscles are week. Mind you I was sendentary for a year. In between I was sent to a podiatrist. He did a faciatendon release. I've never recovered from. I asked over and over could it be the fibro. Now that whole door in pain My question is Should I be doing more to stop my RA. This dr as well said I don't have visable inflammation I can barely use my hands for hours in the morning. And when I finally do it's tough. I am do for my follow up I'm beyond exhausted in pain and weak. What can I do to ease pain and stop progression I now see a rhemy pcp pain management. What avenues have I missed
Regards XXXXXXX
Regards XXXXXXX
Brief Answer:
Is it Fibromyalgia
Detailed Answer:
good evening
Thank you for writing on health care magic
I have gone through your history. there is always a dilemma if it is active rheumatoid arthritis or secondary Fibromyalgia going on.
If your rheumatologist doesn't feel there is visible inflammation but you still feel ko if early morning stiffness, it would be advisable if you get an ultrasound of your hand and feet joints.. along with the blood tests like ESR And CRP. If they are all normal, we at least know there is no disease activity
Fibromyalgia is a diagnosis of exclusion. The other way to approach is, if your rheumatologist doesn't want to do these investigations you can start on tab duloxetine at a dose of 20mg and gradually increasing to 30 mg. If you feel improvement we know it is due to this disease.. But meanwhile you do work on yoga and meditation as they are known to be helpful in Fibromyalgia
I hope the information was useful
Do let me know for more queries
Regards
Dr naval
Is it Fibromyalgia
Detailed Answer:
good evening
Thank you for writing on health care magic
I have gone through your history. there is always a dilemma if it is active rheumatoid arthritis or secondary Fibromyalgia going on.
If your rheumatologist doesn't feel there is visible inflammation but you still feel ko if early morning stiffness, it would be advisable if you get an ultrasound of your hand and feet joints.. along with the blood tests like ESR And CRP. If they are all normal, we at least know there is no disease activity
Fibromyalgia is a diagnosis of exclusion. The other way to approach is, if your rheumatologist doesn't want to do these investigations you can start on tab duloxetine at a dose of 20mg and gradually increasing to 30 mg. If you feel improvement we know it is due to this disease.. But meanwhile you do work on yoga and meditation as they are known to be helpful in Fibromyalgia
I hope the information was useful
Do let me know for more queries
Regards
Dr naval
Above answer was peer-reviewed by :
Dr. Nagamani Ng
Hello Dr Navel
Sorry if I didn't articulate myself clearer. I did have the ultrasounds and it did show in a several joints also bloodwork positive RA factor. I have already been taking duloxetine for 3 years I guess because lately my suffering really increasing. I did better with the Percocet 7'5 4 times a day My Drs are conflicted with this but it did help my life is effected greatly I'm a single mom have to work full time I need to be able to manage my day. I know pain meds only mask pain. That is why I asked if there is something else I need to be taking to stop progression. But then it's so hard at times to know if fibro or RA. Is this my new norm. Hard to get used to the fact I live a painful life. I have no quality work and lie down in exhaustion and pain
Thanks XXXXXXX
Sorry if I didn't articulate myself clearer. I did have the ultrasounds and it did show in a several joints also bloodwork positive RA factor. I have already been taking duloxetine for 3 years I guess because lately my suffering really increasing. I did better with the Percocet 7'5 4 times a day My Drs are conflicted with this but it did help my life is effected greatly I'm a single mom have to work full time I need to be able to manage my day. I know pain meds only mask pain. That is why I asked if there is something else I need to be taking to stop progression. But then it's so hard at times to know if fibro or RA. Is this my new norm. Hard to get used to the fact I live a painful life. I have no quality work and lie down in exhaustion and pain
Thanks XXXXXXX
Brief Answer:
Pain management
Detailed Answer:
Good evening XXXXXXX
Oh well, I dont have any doubt about diagnosis of Rheumatoid Arthritis. The treatment is also going on fine...
But with your ongoing pain...I would have wanted to repeat the Ultrasound..That would give us a fair idea if there is any synovitis( joint inflammation) going on inside which is causing the pain and morning stiffness...IF there is no activity we know it is due to Fibromyalgia...But if there is activity going on, we need to step up the treatment to control your pain..( Either increase the dose of FOlitrax or add another DMARDS)
Secondly, I do feel fibromyalgia is superimposing on Rheumatoid ARthritis and there is a high chance your body has developed resistance to Duloxetine since you have been on a continous use. SO either we can increase the dose a bit or Switch to AMitryptilline which is another drug helpful in Fibromyalgia.
I understand the stress as a single mom and I cant imagine being in your situation..But even you know stress will only worsen the fibromyalgia...So I suggested a bit of Meditation along with it and a bit more stress coping strategies to help you cope up with the disease and your daily routine. Adequate sleep is a must for you. I know it s easier said than done, but somewhere we need to change your routine and thrive for your betterment
Hope the information was useful
Do let me know for more queries
Regards
Dr Naval
Pain management
Detailed Answer:
Good evening XXXXXXX
Oh well, I dont have any doubt about diagnosis of Rheumatoid Arthritis. The treatment is also going on fine...
But with your ongoing pain...I would have wanted to repeat the Ultrasound..That would give us a fair idea if there is any synovitis( joint inflammation) going on inside which is causing the pain and morning stiffness...IF there is no activity we know it is due to Fibromyalgia...But if there is activity going on, we need to step up the treatment to control your pain..( Either increase the dose of FOlitrax or add another DMARDS)
Secondly, I do feel fibromyalgia is superimposing on Rheumatoid ARthritis and there is a high chance your body has developed resistance to Duloxetine since you have been on a continous use. SO either we can increase the dose a bit or Switch to AMitryptilline which is another drug helpful in Fibromyalgia.
I understand the stress as a single mom and I cant imagine being in your situation..But even you know stress will only worsen the fibromyalgia...So I suggested a bit of Meditation along with it and a bit more stress coping strategies to help you cope up with the disease and your daily routine. Adequate sleep is a must for you. I know it s easier said than done, but somewhere we need to change your routine and thrive for your betterment
Hope the information was useful
Do let me know for more queries
Regards
Dr Naval
Note: For further information on diet changes to reduce allergy symptoms or to boost your immunity, Ask here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
Get personalised answers from verified doctor in minutes across 80+ specialties
