Chronic musculoskeletal pain and treatment and occurance
by Nathan Wei, MD, FACP, FACR
Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.
Click here: Second Opinion Arthritis Treatment Kit
(Yes, I know, "occurrence" is misspelled but that often happens during the course of a web search.) The patient who complains of widespread musculoskeletal aches and pains is one of the most challenging in terms of evaluation in rheumatology. And diseases that cause chronic musculoskeletal pain are some of the most common problems that bring a patient to a physician.
Probably the most common cause of this set of symptoms is fibromyalgia (Go to the Site Map to learn more).
However, there are a number of other potential causes:
Among the infectious agents are viral, ricketsial and/or spirochetal infections, and vaccinations. In addition, bacterial infections such as strep can cause disturbing and confusing symptoms.
Drugs are a big cause of generalized aches and pains. Antibiotics such as quinolones and anti-viral drugs like acyclovir have been associated with this symptom complex. Recently, bisphosphonate drugs used for osteoporosis have been reported to cause aches and pains.
Biologic agents such as interferon have done this.
Excessive vitamin A as well as fluoride have caused musculoskeletal symptoms.
Notorious for causing muscular symptoms are the statin drugs.
And cardiac drugs such as nicardipine, propranolol, and quinidine have been reported to do so as well.
Endocrine disorders such as hypothyroidism, hyperparathyroidism, hypercortisolism, corticosteroid withdrawal, adrenal insufficiency, and hypophosphatemia need to be included in the differential diagnosis.
Autoimmune disorder such as inflammatory muscle disease, polymyalgia rheumatica, sarcoidosis, and systemic lupus erythematosus should be considered.
Numerous malignancies and blood disorders such as lymphoma, leukemia, multiple myeloma, metastatic bone disease, and sickle cell anemia should also be excluded.
Hypermobility syndrome is another apparent cause of aches and pains.
Even though this list is formidable, the diagnosis can be reached with a careful history and physical examination.
Questions on history should be aimed at: the presence of constitutional symptoms such as fever, chills, weight loss. Other symptoms to inquire about include: rashes, mouth sores, muscle weakness, sleep disturbance, morning stiffness, hair loss, Raynaud’s phenomenon, muscle cramping.
Careful attention to the patient’s medicine history, past medical and surgical history, family history, and social history might offer valuable clues.
Physical exam should key in on the presence or absence of skin, hair, or nail changes as well as the presence of dry eyes or mouth, swollen lymph nodes, abnormal lung or heart exam, organ enlargement, hypermobility, joint swelling, and other signs suggestive of adrenal, thyroid, and muscle disease. Obviously, painful swollen joints are an important positive finding.
Careful diagnostic laboratory testing should include a complete blood count, chemistries, muscle enzymes, erythrocyte sedimentation rate and/or C-reactive protein, urinalysis, anti-nuclear antibody, rheumatoid factor, anti-CCP, and thyroid function studies.
Imaging studies for specific areas of concern may also be helpful. The use of gadolinium to provide contrast when inflammatory joint disease is recommended. Kidney function should be assessed prior to the use of gadolinium.
The treatment will obviously depend on the diagnosis. Please refer to the Site Map for more information.
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Click here Second Opinion Arthritis Treatment Kit
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