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Arthritis and Rheumatism

Spreading Bilateral Joint Pain

07/27/2009

Question:

The joints in my body (fingers,wrists, elbows, shoulders, spine, hips, knees and ankles) have become increasingly painful and stiff. I am stiff until around 2pm every day, they do not appear to be extremely swollen red or hot. However the middle finger knulckes have increased in size significantly. I am no longer able to wear any rings.

My doctor did blood tests (RA factor, sed rate,etc.) and all came back normal and not suggesting RA. He put me on Cymbalta thinking it was Fibromyalgia but that does not seem to help at all.

My doctor does not see the need to send me to a rheumatologist, with my insurance i would need a referral. Do you have any suggestions on what I can ask my doctor to test next?

Answer:

Testing is typically supplemental to a suspicion produced by history and examination. In other words, the story and the physical exam findings should guide what tests are ordered. That is why a face-to-face visit with a healthcare provider is important. If you still have concerns about an underlying inflammatory arthritis, then a consultation with a rheumatologist may be worthwhile irrespective of your insurance plan. Perhaps you could ask your primary care doctor again if a referral to Rheumatology is warranted.

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Response by:

Raymond  Hong, MD, MBA, FACR Raymond Hong, MD, MBA, FACR
Formerly, Assistant Professor of Medicine
School of Medicine
Case Western Reserve University