“What is the cause of long term joint pain?”
My son is a 33 year old African American male. He was diagnosed with MS three years ago. He was prescribed Tegratol which gave me DRESS syndrome. He was hospitalized for 3 weeks, and treated with steroids which prevented kidney failure. He was also given a spinal tap to rule out lesions in my spine. There were none. Since 2018 he has had severe joint pains which have worsened. The neurologist says joint pains are not MS-related and sent him to a rheumatologist who does x-rays and found nothing wrong with his joints. He is presently on Tecfedera for the MS. He stopped taking it for 3 weeks to see if caused side effects, but the pain is just worsening. He also has bowel problems, constipation, gassy, and occasional diarrhea. Only Ibuprofin gives some relief. Eczema worsens when he gets off the Tecfedera. It's treated with creams. What could be causing his joint pains from his fingers to his ankles?
Male | 33 years old
Complaint duration: 110/12018
Medications: Tecfedera
Conditions: MS
5 Answers
Rheumatologist|RheumatologyRheumatologist
There is a wide array of etiologies for joint pains, treatments and modalities. I will be happy to discuss them in an office visit.
There are a few possibilities that could be causing your son's joint pains. It's important for him to continue working closely with his healthcare providers to investigate further and get an accurate diagnosis. Here are a few potential explanations for his symptoms:
Rheumatological Conditions: While the x-rays did not show any abnormalities, certain rheumatological conditions can cause joint pain that may not be apparent on imaging studies. It might be helpful for your son to consult with a rheumatologist who can conduct a detailed examination, potentially order additional tests, and consider conditions like rheumatoid arthritis, psoriatic arthritis, or lupus, among others.
Medication Side Effects: Some medications, including those used to manage multiple sclerosis (MS), can have side effects that include joint pain or musculoskeletal symptoms. It's important for your son to discuss his concerns regarding his current MS medication, Tecfidera, with his neurologist to determine if there could be a correlation between the medication and his joint pain.
MS-related Symptoms: Although joint pain is not typically considered a primary symptom of MS, some individuals with MS may experience musculoskeletal pain and stiffness. It's important to have your son's MS management assessed by his neurologist to ensure it is adequately controlled.
Gut-related Issues: The bowel problems your son is experiencing may or may not be related to his joint pain. Nevertheless, gastrointestinal conditions such as inflammatory bowel disease (IBD) or celiac disease can sometimes coexist with autoimmune conditions like MS. It may be beneficial for your son to consult with a gastroenterologist to investigate and address his gastrointestinal symptoms.
Other Factors: It's also worth considering other potential factors that could contribute to his joint pain, such as lifestyle factors (stress, physical activity), nutritional deficiencies, or other systemic conditions. A comprehensive evaluation by his healthcare team can help explore these possibilities.
Given the complexity of your son's case and the various symptoms he's experiencing, it's crucial for him to continue working closely with his healthcare providers to determine the underlying cause of his joint pain. They can conduct further evaluations, consider different treatment options, and develop an individualized plan to address his symptoms and overall well-being.
Rheumatological Conditions: While the x-rays did not show any abnormalities, certain rheumatological conditions can cause joint pain that may not be apparent on imaging studies. It might be helpful for your son to consult with a rheumatologist who can conduct a detailed examination, potentially order additional tests, and consider conditions like rheumatoid arthritis, psoriatic arthritis, or lupus, among others.
Medication Side Effects: Some medications, including those used to manage multiple sclerosis (MS), can have side effects that include joint pain or musculoskeletal symptoms. It's important for your son to discuss his concerns regarding his current MS medication, Tecfidera, with his neurologist to determine if there could be a correlation between the medication and his joint pain.
MS-related Symptoms: Although joint pain is not typically considered a primary symptom of MS, some individuals with MS may experience musculoskeletal pain and stiffness. It's important to have your son's MS management assessed by his neurologist to ensure it is adequately controlled.
Gut-related Issues: The bowel problems your son is experiencing may or may not be related to his joint pain. Nevertheless, gastrointestinal conditions such as inflammatory bowel disease (IBD) or celiac disease can sometimes coexist with autoimmune conditions like MS. It may be beneficial for your son to consult with a gastroenterologist to investigate and address his gastrointestinal symptoms.
Other Factors: It's also worth considering other potential factors that could contribute to his joint pain, such as lifestyle factors (stress, physical activity), nutritional deficiencies, or other systemic conditions. A comprehensive evaluation by his healthcare team can help explore these possibilities.
Given the complexity of your son's case and the various symptoms he's experiencing, it's crucial for him to continue working closely with his healthcare providers to determine the underlying cause of his joint pain. They can conduct further evaluations, consider different treatment options, and develop an individualized plan to address his symptoms and overall well-being.
Chronic joint pain is very frustrating for patients as well as for Rheumatologists
I agree that MS should not be associated with chronic joint pain
I would emphasize that not all patients are diagnosed at first visit and it may take some time before a clear diagnosis can be made
Put some faith in your doctors and have patience but continue to advocate for your health
Best wishes!
I agree that MS should not be associated with chronic joint pain
I would emphasize that not all patients are diagnosed at first visit and it may take some time before a clear diagnosis can be made
Put some faith in your doctors and have patience but continue to advocate for your health
Best wishes!
It seems your doctors have done the initial correct steps. You did not mention it, but I assume the rheumatologist also did blood tests to assess for rheumatological diseases, that were negative.
There are two additional categories that should be considered as a cause for the pain.
1) neuropathy - nerve pain. These can be symptoms of small fiber neuropathy with autonomic neuropathy (both variations of the same thing). These can often be autoimmune. The neuropathy would be under the general heading of but there are different variations of that heading which include small fiber neuropathy and autonomic neuropathy. I mention CISP, because there is a recognized overlap syndrome of CIDP and MS occurring in the same patient. This is an autoimmune disease in which part of the same disease affects the nerves (CIDP), and part affects the brain (MS). Diagnosing this required some sophisticated nerve tests, and antibody tests. It is treatable, and would change the MS treatment as well.
2) sleep disruption. It is well recognized that sleep disruption can cause severe generalized pain, sometimes labeled fibromyalgia. This was noted in my earlier papers some years ago, but has recently been confirmed in a study published about year ago:
https://n.neurology.org/content/97/1/e23 <https://n.neurology.org/content/97/1/e23>
There are two additional categories that should be considered as a cause for the pain.
1) neuropathy - nerve pain. These can be symptoms of small fiber neuropathy with autonomic neuropathy (both variations of the same thing). These can often be autoimmune. The neuropathy would be under the general heading of but there are different variations of that heading which include small fiber neuropathy and autonomic neuropathy. I mention CISP, because there is a recognized overlap syndrome of CIDP and MS occurring in the same patient. This is an autoimmune disease in which part of the same disease affects the nerves (CIDP), and part affects the brain (MS). Diagnosing this required some sophisticated nerve tests, and antibody tests. It is treatable, and would change the MS treatment as well.
2) sleep disruption. It is well recognized that sleep disruption can cause severe generalized pain, sometimes labeled fibromyalgia. This was noted in my earlier papers some years ago, but has recently been confirmed in a study published about year ago:
https://n.neurology.org/content/97/1/e23 <https://n.neurology.org/content/97/1/e23>
Here I only address the issue of "joint pain". First thing to know, no pain ever comes from any joint simply because there is no pain sensation in the joint. The so-called "joint pain" actually comes from strain of fascia tissue outside and around the joint and perhaps muscle strain beyond the joint as well. MS certainly does not cause pain in the joint, even no joint pain from arthritis either. Therefore 'joint pain" has nothing to do with joint. The strained muscle/fascia results in pain, stiffness, bulging (such as knuckle pad), limited movement/range/function. These mechanically-strained tissues must be mechanically released to recover with no more pain. This can't be accomplished externally by medication, heat, massage, manipulation, stretching, exercises, etc., but only by the body itself initiated by light touch and hold (The Precision Method), as detailed in my book "NO MORE PAIN All Pain Considered - A Breakthrough". Please visit website: NoMorePainClinic.com.
