Feb 18, 2014
1. Arthralgias and axial pain - emergent autoimmune arthropathy?
2. Marginal zone lymphoma - presentation with extra nodal lesion of right orbit excised 7.3.12.
3. Incidental finding of Hepatitis C infection - treated with antiviral therapy. Cryoglobulinemia.
4. Previous right renal cyst infection - admitted to hospital May 2011 with associated reactive right pleural effusion.
5. Recent uveitis.
6. Bloating and constipation - predominant irritable bowel. Reflux type dyspepsia.
7. Chronic rhinosinusitis.
She is on no active medical therapy for arthritis but has the option of trialing Celebrex. I still want her to complete x-rays of her lumbar sacral spine and sacroiliac joints and she will have two further lab tests which include the cryoglobulins and ANCA. Follow up 12.5.14.
I saw ---- on 17.2.14. Her joint symptoms seem to be improving without having used Celebrex. She has chosen to use Krill Oil, curcumin, Q10 and some digestive enzymes. I am not sure of their efficacy but symptoms are abating.
Her investigations for me did show some immune activation with the lowered C4 complement of 0.17 g/l and the raised C1Q binding assay of 84.0 ug/ml. This was not accompanied by a signal from the antinuclear antibodies, the rheumatoid factor or CCP. There may possibly be an association with ANCA which I will test for and she has had a few spots appear again that might equate with cryoglobulinemia and I will test for that.
On examination there was slight tenderness of the left greater trochanter and the left second MTP joint only. On that basis I think we do not have to rush into very aggressive therapy at all. She can hang back from that, use Celebrex if that does get sorer and I will take the opportunity to review her again in a few months.