Should I See a Rehabilitation or Rheumatology Specialist for My Symptoms?

Should I see a rehabilitation specialist or a rheumatologist for my plantar fasciitis and tennis elbow symptoms?

Hello Doctor: Since receiving the third dose of Moderna (the first two doses were BNT) three months ago, I have experienced the following symptoms starting on the third day: 1) Itching all over my body, which resolved after 4-5 days.
2) Symptoms of plantar fasciitis and tennis elbow.
3) Tenderness in the second joint of my left thumb (pain only when pressed, no pain during normal movement).
Over the past two months, I have been actively rehabilitating for plantar fasciitis and tennis elbow, which has shown some effectiveness, but recovery feels slow.
A month ago, I consulted a rehabilitation physician who tested my CRP at 0.1 mg/dL and ESR (1HR) at 3.
I am a patient with ankylosing spondylitis, which developed at the age of 44.
Occasionally, when experiencing severe morning stiffness, I take NSAIDs, but I may take less than 30 pills in a year.
My CRP/ESR levels have never exceeded normal values, indicating I have very mild ankylosing spondylitis.
However, since receiving the third dose of Moderna, I have experienced the symptoms mentioned above.
I would like to know if my rehabilitation treatment is appropriate, so I would like to ask the doctor: 1) If my symptoms of plantar fasciitis, tennis elbow, and tenderness in the left thumb joint are related to ankylosing spondylitis, is it possible for my CRP/ESR to remain this low? (Can we say that with such low CRP/ESR levels, the likelihood of these symptoms being caused by ankylosing spondylitis is lower?) 2) Would the doctor recommend that I continue treatment in rehabilitation while also consulting a rheumatologist for concurrent treatment? Thank you, Doctor.

Zhong, 50~59 year old female. Ask Date: 2022/12/06

Dr. Zeng Guosen reply Internal Medicine

Users with symptoms of plantar fasciitis, tennis elbow, and tenderness in the left thumb joint may have a potential connection to ankylosing spondylitis.
CRP/ESR tests can be referenced, but they cannot definitively rule in or out the association.
Treatment can be pursued through both rehabilitation and rheumatology, addressing both aspects simultaneously.
The most important thing is to identify the underlying cause for effective treatment.

Reply Date: 2022/12/06

More Info

Based on your symptoms and medical history, it seems that you are experiencing a range of musculoskeletal issues following your third dose of the Moderna vaccine. Your symptoms include itching, plantar fasciitis, tennis elbow, and localized pain in the second joint of your left thumb. You also have a history of ankylosing spondylitis (AS), which is a type of inflammatory arthritis that primarily affects the spine and can lead to chronic pain and stiffness.

1. Connection Between Symptoms and Ankylosing Spondylitis: It is possible for individuals with ankylosing spondylitis to experience pain and discomfort in various joints, including the elbows and thumbs. However, the fact that your CRP (C-reactive protein) and ESR (erythrocyte sedimentation rate) levels are low suggests that there is currently no significant systemic inflammation. This could indicate that your symptoms may not be directly related to your AS but could be due to other factors, such as overuse injuries or post-vaccination reactions. The low inflammatory markers make it less likely that your current symptoms are a direct result of AS flare-ups.

2. Rehabilitation vs. Rheumatology: Given that you have been actively undergoing rehabilitation for your plantar fasciitis and tennis elbow with some positive effects, it is reasonable to continue this approach. Rehabilitation specialists can provide targeted therapies, exercises, and modalities to help alleviate pain and improve function. However, considering your history of ankylosing spondylitis and the new onset of symptoms, it would be prudent to also consult a rheumatologist. A rheumatologist can evaluate your overall condition, assess whether your symptoms are related to AS or another inflammatory process, and adjust your treatment plan accordingly.

3. Dual Approach: It is not uncommon for patients with chronic conditions like ankylosing spondylitis to benefit from a multidisciplinary approach. This means you can continue your rehabilitation treatments while also seeking rheumatological care. The rheumatologist can monitor your AS and determine if any adjustments to your medication or additional treatments are necessary. They may also investigate whether your recent symptoms could be related to the vaccine or if they represent a new issue that needs to be addressed.

4. Monitoring and Follow-Up: Given your symptoms and the recent onset following vaccination, it is essential to keep a close watch on any changes. If your symptoms worsen or new symptoms arise, it would be advisable to seek immediate medical attention. Regular follow-ups with both your rehabilitation specialist and rheumatologist can help ensure that you are receiving comprehensive care tailored to your needs.

In summary, it would be beneficial for you to continue with rehabilitation while also consulting a rheumatologist. This dual approach can help address your current symptoms effectively while keeping your ankylosing spondylitis under control. Always communicate openly with your healthcare providers about your symptoms and any concerns you may have regarding your treatment plan.

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