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Posted by: Doug | 09/01/2020

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Chronic pain and swelling in the knee

Chronic pain and swelling of the left knee, not RA, no diagnosis. What is this? Age: 29 Sex: Male Height: 6'3" Weight: 178 lbs (initially 200lbs) Duration: Just over a year (began Nov 19, 2018) Located in the USA. I have chronic swelling on my left knee, which causes chronic pain and hinders walking. Swelling has previously surrounded other joints as well but has since resolved for the most part. Photos attached. https://imgur.com/a/Z33GwQP/ This began a little over a year ago, and started in my hand (first photo), spreading to my whole hand (second photo), before spreading to my foot and ankle (not pictured) before causing my knee to swell (third and fourth photos, third is during summer 2019, fourth is a week ago). This has all been on the left side of my body. I have seen a rheumatologist regularly. It is similar to RA but not RA. Initial testing showed there was no infection and an elevated ANA. The rheumatologist started me on steroids to weaken my immune system from the get-go, testing showed that my immune response was high and essentially that my immune system was in overdrive. Steroids controlled the swelling in my hand, wrist and foot, but has never been very successful with my knee. When it’s cold outside consistently, I do have the swelling of my ankle and foot return slightly but not nearly what it was. **I am currently taking:** - Methylpredisolone (8mg x 4) daily - Celecoxib (200mg) twice daily - Folic Acid (1mg x 2) daily - Omeprazole (20mg) daily - Methotrexate (2.5mg x 8) daily - Xeljanz (11mg) daily - Tramadol (50mg) as needed for pain but doesn’t really do anything I started seeing a functional health doctor about three months ago and began a strict diet, removing dairy and grain, along with restricting myself to fruits and vegetables and organic free range turkey, fish, and chicken. Since starting this diet I have seen a reduction in the inflammation but it’s not a cure by any means. This change in diet has resulted in the weight loss. Previously I lost 10 lbs when this began, from stress, and it returned. **We have tested:** - Basic metabolic panel (10.1 IU/mL) (stand 0.0-13.9 IU/mL) - **ANA (positive)** - **Rheumatoid Factor (10.1 IU/mL) (stand 0.0-13.9 IU/mL)** - **C-Reactive Protein (16.3 mg/L) (stand 0.0-4.9 mg/L) ** - ENA (all within stand range) - Poct CBC w/Diff (all within stand range) - **Poct Sedimentation Rate (38 mm/hour) (stand 15 mm/hour)** - Celiac Panel (all within stand range) - STI Screening (negative/non reactive) - HIV 1/0/2 (non reactive) - Urinalysis (normal) - C3 Compl

EXPERT’S REPLY

Posted 13/03/2020

A
You clearly have an inflammatory arthritis and the methotrexate is the appropriate treatment. The dose of cortisone should be reduced. If you are still having swelling and the CRP is elevated, your rheumatologist or GP should consider starting Salazopyrine.

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