Chronic Knee Pain and Swollen Fingers: Seeking Further Medical Guidance

Knee joint pain, finger swelling, elevated white blood cell count?

Hello Doctor: I had a cold in mid-December 2017, and it didn't fully resolve until the end of February 2018.
During that time, I visited the emergency room several times due to a fever that lasted for three months (I experienced 2-3 episodes of nosebleeds, but they stopped quickly).
My fever was low-grade, ranging from 37.5 to 38.3°C (now I have a fever of 37.5 to 37.7°C every two to three days).
My white blood cell count was between 11,000 and 14,000.
I consulted a rheumatologist (tests for rheumatoid arthritis and gout were both low) and took medication, but I continue to experience knee pain (pain while walking, pain when straightening, and pain going down stairs) and swelling in my fingers (both hands are swollen, and the finger joints are deformed).
Which specialty should I consult for further evaluation? Thank you! 😊

Qiuqiu, 30~39 year old female. Ask Date: 2018/03/12

Dr. Shi Guozheng reply Orthopedics

You can see an orthopedic specialist.

Reply Date: 2018/03/12

More Info

Chronic knee pain and swollen fingers can be indicative of various underlying conditions, and it is essential to approach this situation with a comprehensive understanding of potential causes and the appropriate next steps for diagnosis and treatment.

Given your history of prolonged low-grade fever, elevated white blood cell count, and the persistence of symptoms such as knee pain and finger swelling, it is crucial to consider several possibilities. The fact that you have already consulted with a rheumatologist and ruled out common conditions like rheumatoid arthritis and gout is a good start. However, there are other conditions that could be contributing to your symptoms.

1. Infectious Arthritis: Sometimes, joint pain and swelling can result from an infection in the joint space. This can occur even after a viral illness, especially if there was any joint trauma or if the infection spread from another site in the body. It would be prudent to have a joint aspiration (arthrocentesis) performed on your knee to analyze the synovial fluid for signs of infection.

2. Autoimmune Disorders: While you have ruled out rheumatoid arthritis, other autoimmune conditions such as lupus or psoriatic arthritis could still be possibilities. These conditions can cause joint pain and swelling, along with systemic symptoms like fever. A thorough evaluation by a rheumatologist, including specific antibody tests, may be warranted.

3. Crystal Arthropathies: Conditions like pseudogout, caused by calcium pyrophosphate crystals, can lead to joint pain and swelling. Although gout was ruled out, it may be worth investigating other types of crystal-induced arthropathies.

4. Osteoarthritis: This degenerative joint disease can cause chronic knee pain, especially if there is a history of joint injury or overuse. It typically presents with pain during activity and stiffness after periods of inactivity.

5. Vasculitis: Conditions that involve inflammation of the blood vessels can also lead to joint pain and systemic symptoms. This would require a specialized evaluation.

6. Other Considerations: Conditions such as fibromyalgia or chronic fatigue syndrome can present with widespread pain and fatigue, but these are usually diagnosed after excluding other conditions.

Given the complexity of your symptoms and the duration of your issues, I recommend the following steps:
- Follow-Up with a Rheumatologist: Since you have already seen one, consider a follow-up appointment to discuss your ongoing symptoms. They may suggest additional tests or imaging studies to further evaluate your joints.

- Consider a Hematologist: If there are concerns about your elevated white blood cell count and persistent fever, a hematologist could help rule out blood disorders or malignancies.

- Physical Therapy: Engaging in physical therapy may help improve your knee function and manage pain. A physical therapist can provide exercises tailored to your needs.

- Pain Management: Discuss pain management options with your healthcare provider. This may include medications, injections, or alternative therapies.

- Lifestyle Modifications: Maintaining a healthy weight, engaging in low-impact exercises, and using assistive devices can help alleviate some of the stress on your knees and fingers.

In conclusion, while you have already taken significant steps in seeking medical care, it is essential to continue advocating for your health. Persistent symptoms warrant further investigation, and a multidisciplinary approach may be necessary to arrive at a definitive diagnosis and effective treatment plan. Please ensure to keep your healthcare providers informed of any changes in your symptoms, and do not hesitate to seek a second opinion if you feel it is necessary.

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