Autoimmune Arthritis: Causes, Symptoms, and Treatment Options

Polyarthritis

1.
I have an ASLO index of 247 (or 274?).
Is this caused by genetics or an infection? My family has a history of almost all hereditary diseases, including lupus erythematosus, ankylosing spondylitis, gout, rheumatoid arthritis, kidney stones, kidney disease, stroke, heart disease, hypertension, diabetes, cancer, and mental illness.
My uric acid levels were elevated 20 years ago with mild stones, but recent autoimmune tests have returned normal.
Do I need to take penicillin or what kind of treatment is necessary? Will this recur in the future? For over two years, I have experienced ongoing pain in my ankles after a sprain, and I frequently re-injure them.
My knees also hurt (mild patellar valgus), and recently, I've had pain in my right groin and inner thigh (other areas still ache).
I cannot sit cross-legged or at a wider angle without pain.
Despite ongoing rehabilitation, there has been no improvement.
Once, I suddenly experienced severe pain in my left hand (mainly in the metacarpal bones, with pain near the elbow) and pain in my right finger joints.
The rehabilitation doctor suggested it might be active arthritis, which could require penicillin treatment; however, the rheumatologist said no special treatment is needed, and that it won't get better, but will cause intermittent pain, requiring medication when it becomes unbearable.
2.
Is this what is referred to as rheumatoid arthritis? Is it hereditary? Does it attack the body like autoimmune diseases? Will it not get better and will it recur? Should I continue with rehabilitation? Is there a way to fully recover?
3.
I also suffered a fracture in my heel bone 18 years ago, which was fixed with screws, but it has not healed since (the old wound has some raised scabs).
Walking for just a few minutes causes pain, which worsens the more I walk, or even just pressing around the heel bone for a few minutes causes pain.
If there is no pressure, there is no pain.
Occasionally, when I come into contact with cold water, the bones ache severely, and recently, my ankles and lower legs have started to ache as well.
X-rays show normal bones, and the doctor said it is a soft tissue issue and suggested soaking in hot water.
What does "soft tissue issue" mean? Why has it not healed in 18 years? What treatment can help?
4.
I started experiencing hair loss three years ago; every time I comb or wash my hair, I lose a handful.
My hair volume has decreased by half, and the gaps between hair roots have widened.
I also frequently get mouth sores, often 2-5 at a time, which take nearly two weeks to heal.
After taking steroids for three weeks in June, I stopped getting mouth sores (but hair loss remained severe).
However, in the last two months, I have started getting mouth sores again, about once every two weeks, healing in about a week or slightly longer.
Additionally, I have experienced night sweats for the past two years, sweating easily, even dripping with sweat on my chest and back in hot weather, whereas before, I found it hard to sweat during exercise.
A few months ago, after taking an imported hormone supplement capsule, I stopped having night sweats, but I still sweat profusely.
Are these symptoms due to immune dysregulation, or are they related to menopause? Should I see a gynecologist, or continue consulting with a rheumatologist for medication? Thank you!

Yang Chong'en, 40~49 year old female. Ask Date: 2015/09/30

Dr. Gao Jiankai reply Internal Medicine

Hello Ms.
Yang, I hope this message finds you well.
Your questions are somewhat complex, and since I haven't actually seen you, many of my thoughts are merely speculation.
It is best for you to discuss these matters with a physician who has examined you in person.
Here are my thoughts:
1.
As far as I know, ASLO (Anti-Streptolysin O) is an indicator of infection, particularly related to streptococcal infections.
However, this indicator should be interpreted in conjunction with clinical symptoms; medication should only be taken if symptoms are present.
We do not prescribe medication based solely on blood test results.
2.
Recurrent joint or muscle pain may be indicative of "recurrent rheumatic syndrome," which is a type of rheumatic condition but is not rheumatoid arthritis and is not hereditary, so there is no need for excessive concern.
If it is indeed recurrent rheumatic syndrome, we would conduct blood tests to check for other rheumatic manifestations, as this condition may be an early symptom of other rheumatic diseases.
If the blood test results are normal, we would consider it "primary" recurrent rheumatic syndrome and advise the patient to take medication only when experiencing pain or inflammation, and not to take medication when asymptomatic.
If you wish to reduce the frequency of episodes, we would recommend maintaining a regular schedule and, if necessary, engaging in regular exercise, which can help soothe immune function and potentially reduce the frequency of episodes.
3.
Previous musculoskeletal injuries may persist for a longer duration; even after improvement, pain may recur with changes in weather, which is why it is often referred to as "rheumatism." The term "soft tissue" refers to the tissues that make up the body's structure, including muscles, tendons, ligaments, and connective tissues.
Therefore, we categorize pain in skeletal muscles and ligaments as "soft tissue" issues.
4.
Hair loss and recurrent mouth ulcers may indicate an abnormal immune function, and you should discuss this with your rheumatologist.
Best regards from the Allergy, Immunology, and Rheumatology Department of Changhua Hospital, Ministry of Health and Welfare.
We care about your well-being.

Reply Date: 2015/09/30

More Info

Understanding autoimmune arthritis, particularly in the context of your symptoms and medical history, requires a comprehensive approach. Let's break down your concerns into manageable sections.

1. ASLO Levels and Their Implications
Your ASLO (Anti-Streptolysin O) level of 247 (or 274) suggests a possible past infection with streptococcal bacteria, which can lead to conditions such as rheumatic fever or post-streptococcal reactive arthritis. This is not necessarily hereditary but can be influenced by genetic predispositions, especially given your family history of autoimmune diseases. The presence of elevated ASLO levels does not automatically indicate an autoimmune disease; it often reflects a response to infection.
In terms of treatment, penicillin may be prescribed if there is a confirmed streptococcal infection or if your doctor suspects that your symptoms are related to such an infection. However, if your autoimmune tests are normal, it may not be necessary. The recurrence of symptoms could be linked to previous injuries or other underlying conditions rather than a direct autoimmune process.

2. Understanding Your Joint Pain
The joint pain you are experiencing, particularly in your ankles and knees, may be classified as reactive arthritis or a form of inflammatory arthritis. This type of arthritis can occur after an infection or injury and may not necessarily be classified as rheumatoid arthritis (RA). While RA is a chronic autoimmune condition characterized by persistent inflammation and joint damage, your symptoms may indicate a different underlying issue, possibly related to soft tissue or joint mechanics rather than an autoimmune attack.

3. Soft Tissue Issues
When your doctor refers to "soft tissue problems," they are likely discussing issues involving muscles, tendons, ligaments, and fascia surrounding the joints. These conditions can lead to chronic pain and may not show up on X-rays. The fact that you have had persistent pain for 18 years following a fracture suggests that there may be ongoing inflammation or scar tissue affecting the soft tissues around the bone. Treatment for soft tissue issues often includes physical therapy, anti-inflammatory medications, and sometimes corticosteroid injections to reduce inflammation.

4. Hair Loss and Other Symptoms
Your hair loss, recurrent mouth ulcers, and night sweats could indicate an underlying autoimmune process or hormonal imbalance. Autoimmune conditions can lead to symptoms like hair loss and oral ulcers due to immune dysregulation. The fact that you experienced improvement with corticosteroids suggests that inflammation may be a contributing factor.
The night sweats and increased sweating could be related to hormonal changes, especially if you are approaching menopause. It may be beneficial to consult with a gynecologist to evaluate your hormonal status and consider whether hormone replacement therapy or other treatments might help alleviate these symptoms.

Conclusion and Recommendations
Given the complexity of your symptoms and medical history, it is essential to maintain open communication with your healthcare providers. Here are some recommendations:
- Follow-Up with Specialists: Continue to see your rheumatologist for your joint pain and autoimmune concerns. A gynecologist can help address hormonal issues related to your night sweats and hair loss.

- Physical Therapy: Engage in physical therapy to address soft tissue problems and improve joint function.

- Monitor Symptoms: Keep a detailed log of your symptoms, including when they occur and any potential triggers, to help your doctors make informed decisions about your treatment.

- Lifestyle Adjustments: Consider dietary changes, regular exercise, and stress management techniques to support your overall health and potentially reduce inflammation.

In summary, while your symptoms may suggest an autoimmune component, they could also be influenced by a variety of factors, including past injuries and hormonal changes. A multidisciplinary approach involving rheumatology, gynecology, and physical therapy may provide the best outcomes for managing your health.

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