Systemic Joint and Bone Itching: Causes and Next Steps

Systemic joint and bone itching can occur in the hands, feet, back, and pelvis?

In 2020, I visited a neurologist due to widespread itching in my bones, along with joint pain in my limbs.
Sometimes, I experience a burning, itchy, painful, and aching sensation, both day and night, which makes me feel the urge to move my body constantly.
There have been nights when the itching and pain disrupted my sleep.
The tests I underwent included: 1.
EEG (Electroencephalogram) during sleep or wakefulness, 2.
Motor nerve conduction studies of the upper limbs, 3.
Motor nerve conduction studies of the lower limbs, 4.
Sensory nerve conduction studies, 5.
F-wave studies, 6.
H-reflex studies, and 7.
Fundus examination.
During my follow-up, the doctor mentioned that there were no significant issues and suggested trying dopamine medication.
However, my family felt that without a definitive diagnosis, I should avoid taking medications that affect the nervous system, so I did not take them.
In October 2022, I went to another hospital's neurology department, but the doctor stated that since the previous doctor had already conducted tests and found no significant problems, further neurological examinations were unnecessary.
Instead, she performed an ANA (Antinuclear Antibody) test, which also came back normal, and advised no follow-up was needed.
By the end of 2022, suspecting rheumatoid arthritis, I visited the rheumatology and immunology department, where I underwent another ANA test along with genetic testing for rheumatoid arthritis.
The ANA levels were elevated, so I was advised to return for follow-up in two years.
However, I have not developed any symptoms or affected other organs, and the genetic testing indicated no such genes.
I would like to ask the doctor, after seeing so many specialists, which department I should consult next or if there are any further in-depth tests I should consider.
This has been ongoing for many years; I had symptoms over a decade ago but only sought medical attention as I grew older, yet there has been no resolution.
I hope the doctor can provide some advice.
Thank you.

zero zero, 20~29 year old female. Ask Date: 2023/07/25

Dr. Peng Shiwei reply Neurology

Hello, I recommend that you consistently see one physician.
If they believe that assistance from another specialist is necessary, they will inform you accordingly.
If you have any concerns about the medication prescribed by your doctor, please discuss them with your primary physician.
Thank you for your inquiry.

Reply Date: 2023/07/25

More Info

It sounds like you have been experiencing a complex array of symptoms, including systemic itching, joint pain, and discomfort that has persisted for many years. Your journey through various medical evaluations and consultations has led you to seek further clarity on your condition. Here’s a comprehensive overview of potential causes, next steps, and recommendations based on your symptoms and medical history.

Understanding Your Symptoms
1. Systemic Itching: Itching can be caused by a variety of factors, including allergic reactions, skin conditions (like eczema or psoriasis), systemic diseases (such as liver or kidney disease), or even neurological conditions. Given that your itching is systemic and not localized, it may suggest an underlying systemic issue rather than a dermatological one.

2. Joint Pain and Discomfort: The joint pain you describe, along with sensations of burning and aching, could be indicative of several conditions, including autoimmune disorders (like rheumatoid arthritis), inflammatory conditions, or even neuropathic pain syndromes. The fact that you have had elevated ANA levels could suggest an autoimmune process, even if you have not yet been diagnosed with a specific condition.

3. Neurological Symptoms: The neurological evaluations you underwent, including nerve conduction studies and EEGs, were appropriate to rule out primary neurological disorders. However, the absence of findings does not completely eliminate the possibility of a neurological component to your symptoms.

Next Steps and Recommendations
1. Follow-Up with Rheumatology: Since you have already seen a rheumatologist and had ANA testing, it may be beneficial to follow up with them, especially given your elevated ANA levels. They may consider additional tests, such as anti-dsDNA or anti-Smith antibodies, which are more specific for lupus, or other autoimmune markers.

2. Consider Dermatology: A consultation with a dermatologist might be worthwhile, particularly if your itching is severe and affecting your quality of life. They can assess for any skin conditions that may not have been previously considered and may recommend treatments such as topical steroids or antihistamines.

3. Explore Allergies: An allergist could help determine if there are any environmental or food allergies contributing to your symptoms. Skin prick tests or serum IgE tests can help identify specific allergens.

4. Pain Management: If your joint pain is significant, a pain management specialist could provide options for managing your discomfort, including physical therapy, medications, or alternative therapies.

5. Lifestyle Modifications: In the meantime, consider lifestyle changes that may help alleviate your symptoms. This includes maintaining a healthy diet, staying hydrated, managing stress, and engaging in gentle exercise, which can help with joint mobility and overall well-being.

6. Document Symptoms: Keeping a detailed diary of your symptoms, including when they occur, their severity, and any potential triggers, can be helpful for your healthcare providers in diagnosing and managing your condition.

7. Seek a Second Opinion: If you feel that your concerns are not being adequately addressed, seeking a second opinion from another rheumatologist or a multidisciplinary team may provide new insights or treatment options.

Conclusion
Your symptoms are complex and multifaceted, and it’s understandable to feel frustrated after multiple consultations without a clear diagnosis. Continuing to advocate for your health and seeking further evaluations from specialists in rheumatology, dermatology, and allergy may help you find answers. It’s important to remain proactive in your healthcare journey, and I encourage you to keep an open line of communication with your healthcare providers about your ongoing symptoms and concerns.

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