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Pain all over: Polyarticular Joint Pain

2 cases: FL

cicada
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Pain all over: Polyarticular Joint Pain

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    1. Pain all over: Polyarticular Joint Pain

    2. 2 cases: FL & EM 17 yo Samoan male Cc:2 weeks of progressive polyarthralgia HPI: Started with acute pain/swelling/erythema of R 2nd/3rd toes while in Samoa. Mom gave him “green gout pill” – “just like your dad’s gout.” toe pain/erythema improved. Then progressive pain: B knees, B ankles, low back, neck, B wrists No trauma, +travel, no insect bites, ROS: no swelling/erythema of joints, no Fever/NS, no dysuria, no penile d/c, wt loss 15# over 2 wks, early satiety, no N,V, no D, no blood in stool, no recent URI/sore throat, no vision changes/eye pain, + depression. PMH: neg. No doctor x >10 yrs Meds: only Samoan green pill.

    3. SH: lives with adoptive parents. Biologic father died 2 weeks ago. Dropped out of school 1 yr ago. HRH: ETOH: 1 pint/day x 1 yr – quit 1 wk ago 2* to pain. + Tob (1/2ppd), + MJ Sexually active, 1 recent time without condom. FH: F: Gout, EtOH. No rheum hx.

    4. Exam: 130/85-86-18-37.2 Obese, well-appearing, painful gait. HEENT: OP: no lesions, nl tonsils. Neck: supple, no LAD CV: RRR, no murmur, rubs Chest: CTAB, no crackles Abd: soft NTND, no HSM Skin: no rash, no nodules Neuro: antalgic gait (using cane), strength, sensation, reflexes intact Extremities: No erythema, no warmth. No obvious effusion/swelling. No deformities. L knee: sl limited extension. Tender at bilat joint line. Ankles: B tender on medial side, NT malleoli. FROM R wrist: ?sl edema. Tender over carpal radial > ulnar side. FROM Feet: Nl Spine: no point tenderness. Paraspinal cervical/lumbar pain c FROM. No scoliosis.

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