Allergy masquerades with joint pain


If it comes with an itch or a sneeze

Or a rash or even a wheeze

     It could be joint pain

     Or even a migraine

The diagnosis might be allergies

  One April day long ago (I won’t say where), a young woman came to see me with joint pain of two weeks duration.  She had the characteristic history items that went along with rheumatoid arthritis: swollen joints,  morning stiffness lasting two hours, gelling (stiffening up if she sat for more than half an hour), and fatigue and malaise.  I ran all the right blood work, and when we met the next week I assured her the results had come back normal.  I prescribed a non-steroidal anti-inflammatory drug (NSAID) for her joint pains, and I didn’t see her till she returned a year later.  The joint pains had lasted, she said, six weeks after she’d seen me, the NSAID didn’t help, and now the joint pain had returned.  I ran the right blood work again, and again she returned to normal results a week later, and got a prescription for a different NSAID.

Thus we met every spring for seven years, and six NSAIDs didn’t help.  I said, “Look, I can see you’re miserable, and because of personal experience I have real sympathy, but the blood work has all come up normal.  I’ve looked through your chart, and, give or take ten days, you’re here every April.  Even though the symptoms look like arthritis, the timing looks like allergy.  Let’s see how you do with an antihistamine.”  I gave her a prescription for Seldane (since removed from the market because of some nasty complications).

She called three hours later to announce her joint pain had completely resolved.

Since May I’ve run into a couple of other patients who have had arthritis-like symptoms but whose clinical progress has been less than satisfactory.  One has done reasonably with a change of diet based on a theory I can’t support. 

I’ve had some of them try Zyrtec, an over-the-counter antihistamine.

(When Zyrtec, or certrazine, went over-the-counter, my summer allergy business disappeared.  Instead of taking care of hundreds of patients with itchy, watery eyes, itchy, watery nose, and volley sneezes, from May through September, I might take care of a dozen; usually the few who do not respond to Zyrtec.)

Allergies can behave strangely.  Though I’ve never seen a case, fixed drug eruption occurs when a few square centimeters of body surface have an allergy to a medication.  I’ve seen documented cases in the literature where people have had a rash in reaction to tap water.

We can take away several morals:

You can’t have good medical care without good medical records.

Anyone can have any reaction to any drug.

Allergies don’t always involve sneezing.

Common things happen more commonly than uncommon things, but uncommon things still happen.

If the patient gets better as a result of a crackpot theory, don’t write off the theory

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2 Responses to “Allergy masquerades with joint pain”

  1. Charlie Miles Says:

    Also if a crackpot gives you a sound theory, don’t dismiss the theory either!
    🙂

  2. Steve Gordon Says:

    It’s true; a madman can speak the truth, and a sane man can lie. Reason is reason.

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