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Rheumatology findings

Feb 18, 2014 - 1 comments

Problems    
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.

Management
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.
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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.


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548668 tn?1394187222
by Kristina538, Feb 20, 2014
Thank you Diana!!  I wondered what the unopened Celebrex in my medicine cabinet was for ;)!!   Hopefully the pain will continue to dissipate, until, like me, it seemed to disspate to the point it had actually gone!.  

(I'd love to hope that the bloating, constipation and rhinosinusitis do the same - your immune system will still be compromised at present, but it'll be interesting too, to see whether your next thyroid tests are in the upper of the normal range, or lower.  Hugs for improvements xx

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