Sore wrist swollen lymph node
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.
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Information, in part, from the American College of Rheumatology and the Arthritis Foundation
Many many conditions- some common, and others not so common- can cause this condition.
The first category to consider is infectious diseases.
Generalized systemic infections that may be responsible for this syndrome include streptococcal infections, viral infections such as hepatitis, rubella, parvovirus, coxsackie, EBV (Epstein-Barr virus) CMV (cytomegalovirus),HIV (AIDS), Lyme disease, tuberculosis, and Ehrlichiosis.
Infectious endocarditis- an infection of the heart valves- may also cause swollen lymph nodes and joint soreness.
Generally, with systemic infections a patient will have constitutional symptoms such as fever, chills, malaise, fatigue, sore throat, headache, and possibly a rash.
The history, physical exam, and laboratory tests will help narrow down the list. Unfortunately, while some patients may recall a possible exposure situation, others may not.
Animal bites (dog) and cat scratches or infections from contaminated cuts in the hand (e.g., cleaning a fish tank- Mycobacterium marinum) can also lead to wrist swelling and soreness along with swollen lymph nodes.
Sarcoidosis, an autoimmune disease that affects the lungs, joints, and sometimes the eyes, brain, and heart may also present with soreness in the wrists and lymph node swelling.
A chest x-ray and laboratory tests including an angiotensin converting enzyme test may be helpful in establishing the diagnosis.
Inflammatory bowel diseases such as Crohn's disease are another cause of this symptom complex. A history of abdominal pain, diarrhea, and bloody stools may lead to this diagnosis being made.
Cancers, such as leukemia and lymphoma are on the list and need to be considered. A history of weight loss and night sweats along with bleeding gums may be elicited.
Finally, the category where many diseases are capable of producing these symptoms is the autoimmune arthritis category.
SLE (lupus) is a common autoimmune disease that often presents with a photosensitive rash, fever, malaise, swollen lymph nodes, and arthritis. In serious cases internal organ involvement with the kidneys, central nervous system, lungs, and blood may occur. Laboratory testing show positive anti-nuclear antibody tests along with other autoantibodies. The treatment consists of anti-inflammatory medicines, hydroxychloroquine (Plaquenil), rest, and physical therapy. Often, stronger immunosuppressive drugs are needed. It is critical to exclude an infectious problem in patients with lupus who present with lymph node swelling, painful joints, and fever.
Another rarer cause is adult onset Still’s disease. This is an inflammatory condition that attacks internal organs and joints. In very severe cases, AOSD becomes chronic and extremely debilitating, causing severe pain and stiffness.
There are treatments, mainly anti-inflammatory drugs, that help with most AOSD symptoms. The disease can be difficult to diagnose, as it is difficult to distinguish from a number of other conditions that cause unexplained fever as well as other forms of inflammatory arthritis.
The first sign that someone may be coming down with AOSD is a high spiking fever of 103 degrees or above. The fever usually rises rapidly in the evening and then subsides to or near normal by the next morning. Occasionally, an unusual pattern of two fever spikes in a day is seen in one-fifth of AOSD sufferers.
The typical Still's rash is salmon pink in color and comes and goes unpredictably, although it sometimes occurs at the same time as high fever. It is most common on the chest and thigh, although it may also appear on the face, hands and feet. In some cases, the rash becomes itchy.
At some point, every AOSD sufferer experiences intense joint pain, often in the hand or wrist. This can be accompanied by severe muscle pain as well. Both may become worse during a fever spike.
Most AOSD sufferers have a sore throat that is usually described as a severe, constant burning pain in the area around the pharynx.
Other symptoms include pain, difficulty breathing and other problems.
This disease is accompanied by swollen lymph nodes, as well as enlargement of the spleen or liver. These symptoms are also sometimes attributed to other causes.
These can be easily detected using a variety of blood tests. Most patients with AOSD have greatly elevated white blood cell counts which may indicate an underlying infection or even leukemia. However, the cultures of the blood and other sites are always negative and the blood and bone marrow do not show the abnormal cells found in leukemia. Acute phase reactants are almost always abnormally elevated in AOSD. The two most commonly associated with AOSD are an elevated sedimentation rate (ESR) and a high blood ferritin level.
While there is no simple test for AOSD, most doctors will make the diagnosis if a person has five or more of the criteria below, including two or more from the first (major criteria) list:
Major AOSD Criteria
1. High fever lasting one week or longer
2. Joint pain lasting two weeks or longer
4. Abnormal white blood cell count and other blood problems
Minor AOSD Criteria
1. Sore throat
2. Swelling of the lymph nodes or spleen
3. Liver problems
4. Absence of rheumatoid arthritis
Non-steroidal anti-inflammatory drugs (NSAIDS) are usually used first. A good early indication of how well an AOSD sufferer will do in the long term is their initial response to these drugs. Roughly, 20-25% of AOSD sufferers improve with NSAIDS alone. NSAIDS are normally taken until 1-3 months after the symptoms are gone.
In particularly acute or severe cases, doctors sometimes also prescribe corticosteroids to address heart, blood, and other life-threatening problems that AOSD can cause.
Doctors also may prescribe drugs such as methotrexate, hydroxychloroquine and azathioprine. The newer anti-TNF drugs may also be used.
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