Persistent Ankle Swelling: Seeking Solutions After One Year of Discomfort

Swelling and fluid accumulation in the right ankle that has persisted for nearly a year, seeking help!

I have been suffering from swelling in my right ankle for almost a year (my left ankle is normal)!!! I have seen various traditional and Western medicine practitioners, undergone massage, acupuncture, electrical therapy, shortwave therapy, ultrasound, heat and cold treatments, and had fluid drained, but nothing has helped! I am in tears.
After blood tests, a doctor at Asia University Hospital suggested rheumatoid arthritis, but it is atypical.
The anti-CCP test was negative, with only a score of 3 for rheumatoid factor, 1 for ankle swelling, and 1 for erythrocyte sedimentation rate.
With a total score of less than 6, I was not prescribed immunosuppressants.
I took anti-inflammatory and pain relief medications for a month, but the swelling did not subside.
A doctor at Veterans General Hospital suspected gout, but the MRI showed that my ankle is filled with fluid.
I have been taking colchicine along with anti-inflammatory and pain relief medications, yet there is still no reduction in swelling.
Is there anyone who can help me? I feel so hopeless...

Xun, 30~39 year old female. Ask Date: 2017/08/25

Dr. Zhou Jianwen reply Rehabilitation

It is recommended to follow up with a rheumatologist for monitoring and evaluating treatment.

Reply Date: 2017/08/25

More Info

Persistent ankle swelling can be a frustrating and debilitating condition, especially when it has lasted for nearly a year despite various treatments. Your experience of seeking help from multiple healthcare providers, including both traditional and alternative therapies, highlights the complexity of diagnosing and managing musculoskeletal issues.
The fact that you have undergone a variety of treatments—such as acupuncture, physical therapy, and medication—suggests that you are proactive in seeking relief. However, the persistence of your symptoms indicates that there may be underlying factors that have not yet been fully addressed.
From your description, it seems that your doctors have considered several potential diagnoses, including rheumatoid arthritis and gout. The negative anti-CCP test and the low rheumatoid factor suggest that classic rheumatoid arthritis may be less likely, but it does not completely rule out other inflammatory conditions. The elevated erythrocyte sedimentation rate (ESR) indicates some level of inflammation in your body, which could be due to various causes, including autoimmune disorders, infections, or even chronic conditions like osteoarthritis.

The MRI results showing fluid accumulation in the ankle joint are significant. This could indicate a condition known as "joint effusion," which can occur due to inflammation, injury, or infection. Since you mentioned that the colchicine (used for gout) and anti-inflammatory medications have not alleviated the swelling, it may be worth considering other potential causes of your symptoms.
Here are some suggestions for further steps you might consider:
1. Second Opinion: If you haven't already, seeking a second opinion from a rheumatologist or an orthopedic specialist could provide new insights. They may suggest additional tests or imaging studies to clarify the diagnosis.

2. Comprehensive Evaluation: A thorough evaluation of your medical history, physical examination, and possibly more advanced imaging (like ultrasound or repeat MRI) might be necessary to assess the joint and surrounding tissues more closely.

3. Consider Other Conditions: Conditions such as chronic venous insufficiency, lymphedema, or even complex regional pain syndrome (CRPS) could also lead to persistent swelling. A vascular specialist may be able to assess for venous issues.

4. Physical Therapy: Engaging in a structured physical therapy program tailored to your specific needs may help improve mobility and reduce swelling. Therapists can provide exercises that promote circulation and strengthen the surrounding muscles.

5. Lifestyle Modifications: Consider dietary changes that may help reduce inflammation, such as adopting an anti-inflammatory diet rich in fruits, vegetables, whole grains, and omega-3 fatty acids. Staying hydrated and managing weight can also be beneficial.

6. Medication Review: Discuss with your healthcare provider the possibility of adjusting your current medications or trying different classes of drugs that may be more effective for your specific condition.

7. Alternative Therapies: While you have already tried various alternative therapies, some patients find relief through methods like hydrotherapy, yoga, or tai chi, which can promote movement without putting excessive strain on the joint.

8. Mental Health Support: Chronic pain and persistent health issues can take a toll on mental health. Seeking support from a mental health professional can provide coping strategies and emotional support during this challenging time.

In conclusion, persistent ankle swelling can be multifactorial, and it often requires a multidisciplinary approach to find effective treatment. Continue advocating for your health, and do not hesitate to seek further evaluations or alternative opinions. Your well-being is paramount, and with persistence, you may find the answers and relief you are seeking.

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