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What Causes Pain In Right Hand Knuckle Area, Legs, IBS And Sleep Apnea?

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Posted on Wed, 15 Jun 2016
Question: This is directed to a Rheumatologist:

67 year old female:
with one year of college, 5'5", wt. 203# Diabetic II since 2006 or 2007; Current complaint: body aches.
Visited my rheumatologist yesterday for my regular screening before proceeding next to my 4th Remicaide infusion for psoriasis & psoriatic arthritis, as unable to continue methotrexate because of increased liver enzymes. Recorded pain intensity at Rheumatology appointment before infusion was "1" with focus on knuckles of right hand mainly.Order written to increase from 500 mg to 600 mg of remicaide @ infusion to run 2 hours q 8 weeks.
Past week history:
New intense pain in right hand knuckle area involving thumb & 3rd finger(all knuckles with less pain on index finger vs. less pain in knuckles of left hand. When connecting iv yesterday for infusion the nurse made one unsuccessful attempt at inserting iv before having success. That attempt caused me to writhe in pain, resulting in bruise on left arm. I normally do not react to needle insertion except maybe gritting teeth. Have been told by physicians in past I appear to have high tolerance for pain as did my mother. Came home after rheumatology & remicaide appointments & errands; had arthritic pain arising in additional areas of body thru the evening, as well as some shooting pain in knuckle area of both hands; went to bed 9pm. because of pain & uncomfort. Woke from intense all over body pain bout 11:15 pm. Had suffered very similar pain about 10 years ago I & less till now, with similar overall pain in body from mowing lawn for short time, maybe 15 minutes. Addition lawn mowing attempts resulted in same body reaction. Suffered all over body pain & lots of sweat from short time of mowing lawn. Mowing was new job for me after being widowed. I would mow short area of lawn in heat & have to come into house & lie in front of a fan. I was hot & drained of energy & it could be anytime of day, therefore different temperatures of the day. Lying in front of fan always helped me feel better even though I had an airconditioned home which was always very cool. I usually would fall asleep & extremely exhausted probably from the effort of mowing the lawn & loss of sweat. I gave up lawn mowing but working in garden could cause same affect. I was diagnosed in 2005 or earlier with fibromyalgia but I questioned the accuracy of the diagnose, but clinician was a fibromyalgia sufferer as well. She was very exact in her diagnosis when I questioned her.
In the last 24 hours:
Some of my pain has only been on bilateral areas of my body when not full body. Most recently, napping today I woke up with pain in both legs just below calf area to ankle area & not in ankle joint area unless the radiating pain is hard to distinguish. Last night at some point I awoke with just pain bilaterally in outside lower extremities from front half of extremities to back half. Pain stopping in center. From inside of leg, there was no pain. If my memory is correct it was the leg area above knee. In March 2016, I was hospitalized with uncontrolled diabetes but am working hard now on maintaining control. I have osteoarthritis, psoriatic arthritis, psoriasis (skin clear for year or two with new recent outbreaks in last two months, irritable bowel syndrome, sleep apnea. Surgeries include tubal ligation, breast reduction, right metacarpal surgery, sinus surgeries x 2, without total relief; as well as 4 live births. I am fairly active at home, with household chores & have been moving furniture to rearrange rooms; I do not walk outside as exercise or do other routine exercise. I get pain shots for my arthritic right hip pain q 4 months which is why I do not walk regularly. Our weather here in South XXXXXXX has been very turbulent with possible tornado conditions developing. I feel possibly to some extent, my full body (arthritic) pain is reacting to our weather which is typical for me but not normally, full body reaction & with such severity that makes sleep impossible. With the severest part of & my "full" body pain being last night, I was very close to tears & my doctor is 50 miles away.
I did get relief last night with a hot bath with epsom salt & a mixture of ibuprofen & tylenol which is not beneficial to my liver with increased enzymes resulting from non-alcoholic fatty liver (dx:2005) & a few years on methotrexate. Arthritis is in my family history as well as as increased liver enzymes in my genealogy (23andMe). My paternal grandmother always was in a wheel chair which she referred to as "rheumatitis". I have no additional information to support discern definition of rheumatitis' during the 1920 to 50's. My labs from approximately 1979 have resulted in positive rheumatoid factor. My lab results yesterday had increase sed rate & one other inflammatory lab indicator was slightly elevated. Cannot remember lab name from phone conversation with nurse. My last blood sugar reading today @230pm was 147.
Could this be a reaction to the tornadic weather as well as to the increased remicaide or do you think there is another diagnosis going on? Would rest or exercise (yoga) be the better alternative to relieve pain?
Waiting to hear from my doctor but would appreciate another opinion. I am likely sharing my information with you, some necessary but not necessarily shared with my regular doctor as as you well know, in the doctor's office, we tend to forget a lot that should be shared.
Thank you.
Judy
email: YYYY@YYYY or text 605-890-1448
doctor
Answered by Dr. Dr. Shruti Rijhwani (2 hours later)
Brief Answer:
It seems like the disease activity is precipitataed due to weather .

Detailed Answer:
Dear XXXXXXX

Thank you for posting your query on HCM.

Well having gone through your complaints fully , it is unlikely that the pain is aggravated by increased dose of remicade , there are two possibilities either you are having a flare of symptoms which is common with this disease for which remicade was increased , other thing is sometimes sudden weather change also leads to such exacerbation .

I read that you are going to start prednisolone from today , so I believe your symptoms will settle down with that , other thing I would suggest you to avoid NSAIDS like ibuprofen since your liver is affected rather you can go for tramadol or paracetamol for pain relief .

One thing I will like to see is your muscle enzyme CPK if it has been done . And yes I will advise you to take rest during this period till inflammation settles .

Take care.

Dr. Shruti
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
doctor
Answered by
Dr.
Dr. Dr. Shruti Rijhwani

Rheumatologist

Practicing since :2008

Answered : 2366 Questions

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What Causes Pain In Right Hand Knuckle Area, Legs, IBS And Sleep Apnea?

Brief Answer: It seems like the disease activity is precipitataed due to weather . Detailed Answer: Dear XXXXXXX Thank you for posting your query on HCM. Well having gone through your complaints fully , it is unlikely that the pain is aggravated by increased dose of remicade , there are two possibilities either you are having a flare of symptoms which is common with this disease for which remicade was increased , other thing is sometimes sudden weather change also leads to such exacerbation . I read that you are going to start prednisolone from today , so I believe your symptoms will settle down with that , other thing I would suggest you to avoid NSAIDS like ibuprofen since your liver is affected rather you can go for tramadol or paracetamol for pain relief . One thing I will like to see is your muscle enzyme CPK if it has been done . And yes I will advise you to take rest during this period till inflammation settles . Take care. Dr. Shruti