Unexplained Migrating Joint Pain in a Man in His 70s: Exploring Potential Causes
Hello medical professionals, I'm reaching out regarding my father, who is in his early 70s. He has recently been suffering from **migrating joint pain, stiffness, and extreme fatigue** that started a few weeks ago. # History of Symptoms: * He first experienced **chills**, subsequently developing **joint pain and stiffness** in several locations including his feet, hands, wrists, neck, groin, and the sole of one foot. * The **pain tends to move around**, affecting different joints each day. * So far, there are no signs of fever, rash, mouth sores, or Raynaud’s phenomenon. # Laboratory Findings: * **CRP level: 107 mg/L** * **Slight elevation in white blood cell count** * **Mild normocytic anemia noted** * Joint aspiration performed revealed **no signs of infection or gout** * Both kidney and liver functions are within normal ranges. * Testing for autoimmune markers (RF, anti-CCP, ANA, etc.) has not yet been done. # Additional Background: * A few weeks ago, he had a **broken tooth accompanied by an infection**, which was treated with antibiotics. * He had an active lifestyle but now **requires two naps each day** due to fatigue. * He has found relief with **NSAIDs (Nurofen)**. # Current Status: * His general practitioner described the case as “atypical,” and we are currently awaiting a rheumatology referral, which may take a few weeks. * I am worried this could potentially indicate **seronegative RA**, **reactive arthritis**, or perhaps another type of inflammatory disorder. **What considerations should we be making or eliminating at this point?** Would it be reasonable to initiate a short course of prednisone if the CRP remains elevated and his symptoms do not improve?
Answers (1)
4/1/2025, 7:50:40 AM
OpenHealth AI
I understand your concerns about your father's migrating joint pain and extreme fatigue, particularly given his age and history of symptoms. It's essential to approach this situation with care, as there are several possibilities that could explain his condition. Below are key points to consider and next steps to take.
Main Points:
- Migrating joint pain in an elderly patient can suggest an inflammatory process, potentially autoimmune or post-infectious in nature.
- Elevated CRP and slight anemia indicate some systemic inflammation that needs to be addressed.
- Immediate steps include tracking symptoms and considering supportive treatments.
Explanation:
Migrating joint pain can occur due to various conditions, including rheumatoid arthritis, reactive arthritis, viral infections, or other inflammatory disorders. The lack of fever and specific signs like rash or mouth sores is helpful because it does narrow down potential causes somewhat.
His elevated CRP level hints at inflammation, while the mild normocytic anemia suggests a systemic issue that warrants further investigation. Usually, serologic tests for autoimmune diseases (like rheumatoid arthritis or lupus) are important next steps.
Next Steps:
-
Monitor Symptoms: Keep a detailed diary of his joint pain: which joints are affected, the intensity, duration, and any correlating factors (like activities or food). This can help healthcare providers understand the pattern better.
-
Consider Lifestyle Adjustments:
- Encourage hydration. Promote a balanced diet rich in anti-inflammatory foods (like fruits, vegetables, whole grains, and omega-3 fatty acids).
- Gentle exercises, like stretching or swimming, can maintain joint mobility without exacerbating pain.
-
Medications:
- Since NSAIDs provide relief, continue using them as directed. However, keep an eye on side effects, especially with prolonged use.
- Discuss with the primary care physician about the potential risks and benefits of starting a short course of prednisone. Prednisone can help manage inflammation but should be used cautiously and under supervision due to potential side effects.
-
Follow-up on Tests:
- Ensure that the requested autoimmune marker tests, including RF, anti-CCP, and ANA, are carried out promptly. These will provide more clarity on the underlying cause of his symptoms.
-
Prepare for the Rheumatology Appointment:
- Compile all medical history, lab results, and symptom records. This preparation will make it easier for the rheumatologist to assess and guide appropriate treatment.
While awaiting the referral, your father’s comfort and quality of life are paramount. Hope for relief as you pursue these steps, and feel free to reach out for more specific advice if needed.
Related Questions
Persistent Pain in Right Shoulder and Arm After Lifting
Hello, everyone! I’m a 23-year-old male and have been engaged in weightlifting for several years now. Recently, I’ve been struggling with ongoing discomfort in my right shoulder and arm, which I haven’t been able to accurately identify. The pain manifests during particular movements, especially with lateral raises or when my arm is raised to shoulder level while rotating my wrist. Certain pressing and pulling activities can also provoke this discomfort. Rather than feeling sharp, it’s a deep, nagging sensation that sometimes seems localized in the front area of the shoulder or at the biceps tendon, and at other times it feels more like it’s situated between the shoulder and upper arm. Fortunately, there’s no numbness or tingling involved. This issue began while I was working out. I decided to take a break for around two months, but when I returned, the pain persisted. After consulting a physician, I was diagnosed with bicipital tendinitis. Since then, I’ve reduced my upper-body workouts, completely steering clear of shoulder exercises and heavy lifting, and have begun a gentle rehabilitation regimen focusing on external rotations, pendulum movements, and scapular exercises. Despite adhering to this routine for about a week, I haven’t experienced any noticeable improvement. Is it typical for this type of tendon injury to require an extended period for recovery? At what point should I consider diagnostic imaging, such as an ultrasound or MRI? Additionally, are there frequent rehabilitation errors that might impede the healing process? I appreciate your insights in advance!
Understanding EEG Results for My 22-Month-Old Son: Insights Needed
Could someone help clarify this for me? My son, who is just 22 months old, hasn’t started walking yet, becomes tired easily, and has been experiencing behavioral outbursts. He had a febrile seizure in February 2025, followed by another unexplained seizure in April 2025, which led us to consult a neurologist. Since he was 3 months old, he has been receiving therapy from a physical therapist for torticollis. At birth, he spent five days in the NICU due to issues with meconium aspiration. A recent MRI showed normal results, and he also had a follow-up EEG after one conducted in July 2025. The results from this recent EEG were abnormal for a pediatric patient in awake, drowsy, and sleeping states. Notably, there were brief episodes of left frontotemporal delta slowing, which occurred mainly when he was awake and drowsy. There were no signs of epileptiform activity detected. In contrast, the EEG performed back on July 3, 2025, was deemed normal for both awake and drowsy states, again with no evidence of epileptiform irregularities, although it did not capture any sleep data. This examination was prompted by the child's existing history of febrile seizures. Importantly, he is not currently on any anti-seizure medications. The EEG procedure used standard electrode placements per the 10-20 system, conducted a single-lead EKG, and included continuous video monitoring. During the analysis, the background activity was symmetric, indicating some anterior-posterior (AP) organization, with a dominant rhythm of 50-80 microvolts at 7 Hz. His drowsy state was marked by a reduced amount of eye blink activity, less breathing motion interference, and a generalized slowing in theta/delta frequencies. Stage II sleep exhibited spindles and vertex waves patterns. Additionally, there were intermittent bursts of 250-300 microvolts in the left frontotemporal region with semi-rhythmic activity of 2-4 Hz, mostly observed during wakefulness and drowsiness. No definitive epileptiform discharge was noted. Photic stimulation during the test did not elicit a strong response, and hyperventilation was not conducted during this session.
INTENSE Spine Discomfort, Breathing Difficulties, Muscle Twitches, and Sweating
To elaborate on the situation mentioned in the title, I’ve been experiencing unusual muscle twitches and spasms for the past few days, along with some discomfort in my back. However, today, I felt an unexpected sharp pain shoot through my spine, which has left my legs feeling numb and made it impossible for me to sit up straight. Additionally, I’ve been dealing with cold sweats for the last hour and struggling to breathe properly. Perhaps I’m just overanalyzing things and it’s a common occurrence, but the intensity of the pain is overwhelming—it's truly unbearable. I’m shaking quite a bit, and unfortunately, my parents aren’t responding to my attempts to reach them for help. I have a history of a chronic heart condition and arthritis, yet I’ve never experienced pain this severe, especially in my spine. For context, I am nearly 15 years old and female. My current medications include pain relievers, anxiety medication, beta blockers, and some vitamins, though those specifics may not be particularly relevant. I don’t smoke; however, I have tried vaping a few times, which might not matter much, but I thought it was worth mentioning as it was requested.
Understanding Atrial Fibrillation and Thyroid Issues: Variability in Cardioversion Decisions
Hello everyone, I’m reaching out for guidance regarding my mother’s current health situation, and I’d greatly appreciate any shared experiences or thoughts. **My mother's background:** - **Age**: 55 years - **Weight**: Recently dropped to 116 kg from 118 kg in just two days, likely due to diuretics. - **Health history**: Previously an underactive thyroid, undiagnosed and untreated, now presenting as overactive. - **Medications**: Currently taking thyroid medication and a beta-blocker (Rapiblock). **Current health status:** My mother has been hospitalized since Tuesday, experiencing **atrial fibrillation with heart rates exceeding 200** beats per minute due to her thyroid's hyperactivity. - The plan for cardioversion was initially settled on Tuesday. However, the following day, the medical team advised postponing it until her thyroid levels could be stabilized, believing that her heart rate would return to normal once her thyroid condition was managed. - Her **obesity** precludes her from undergoing a transthoracic echocardiogram, and due to her thyroid concerns, she cannot handle contrast dye (this has been a consistent issue for over four years). Therefore, the only feasible option was a **transesophageal echocardiogram (TEE)**, which has yet to be performed. - She has been prescribed various medications including beta-blockers and thyroid treatments in the past. - On Friday, a doctor proposed proceeding with cardioversion; however, the attending senior physician objected. - Today (Saturday), another clinician has expressed a desire to move forward with cardioversion, having initiated a new medication, as the senior physician is unavailable. - **Communication has been unclear**, as we were notified of developments by a nurse rather than the physician in charge, causing confusion and anxiety. - Currently, only a **chest X-ray** is scheduled, and the TEE remains unaddressed. **My inquiries are as follows:** 1. Is it common for medical professionals to have varying opinions and frequently revise medication or treatment plans like cardioversion? 2. Is it safe to conduct cardioversion in the absence of a TEE? I presumed that this was a standard procedure to exclude the presence of blood clots. 3. Is it usual practice to have only a chest X-ray prior to moving ahead with cardioversion? 4. How typical is it for patients or their families to not be directly informed about treatment changes and learn about them through nursing staff instead? I recognize that this cannot substitute for professional medical advice. I’m simply trying to discern whether these circumstances are typical or if we should express our concerns more assertively with the healthcare facility. Thank you for your insights!
28-Year-Old Male Experiencing Scalp Sensations Post-Amitriptyline Treatment
I am a 28-year-old man in generally good health, without any cardiac concerns. Approximately a month ago, I encountered intense pain localized to one side of my head, which was unresponsive to paracetamol. However, a single dose of a migraine treatment provided substantial relief. Following that, I began a regimen of amitriptyline, starting at a nightly dose of 10 to 25 mg. While my head pain has diminished significantly—by about 90 to 95%—I now experience occasional uncomfortable sensations on my scalp. These feelings include pins and needles, a cooling sensation, and some crawling feelings near my hairline and ears. There are fleeting moments where I feel brief throbs lasting a second, but I do not have any persistent headaches. To clarify, I do not experience any of the following: - Nausea - Weakness in my limbs - Numbness - Changes in my vision - Coordination difficulties - Seizures The symptoms I have are transient, shifting around and often intensifying when I become conscious of them or as the day progresses. I would like to know: Is it common to experience these sensations during the recovery stage following episodes of neuralgia or migraine-like discomfort? Additionally, could the amitriptyline potentially be causing these temporary paresthetic sensations? I am seeking some reassurance or advice on what is typically observed during this healing process. Thank you.