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Do I have a rheumatological problem?

Q: I am a 26 years old girl suffering from joint pains. I am having mild pain in my wrists, feet, ankles and elbow. When I wake up in the morning the pain is less as I feel my joints have got rest but there is little cracking when I get up. During the day there is more stiffness than pain. When I press my wrist they feel sore and painful. My rheumatologist has conducted the following tests - RH,lupus osteo (negative), CRP (0.5), Anti CCP Antibody test (less than 20) and ESR (25). He has done X-rays for my wrists and feet. They seem to be normal but he said the calcium was a bit low and the bones were thin. I have not done an ultrasound. My doctor had put me on Mobic for a month but since the pain didn't go away he changed the medication to Lodine (Etodolac) 500 mg twice a day. I do feel the pain and stiffness has decreased or being the early stage I should be (using anti-TNF agents or combos of DMARDs). As most arthritis don't show up in the blood being the early stage do you think my situation is curable.

A:In the absence of early morning stiffness and all the usual tests for inflammatory markers being negative along with negative RF and anti-CCP, it is very unlikely that you have any serious problem. There is a condition called fibromyalgia and a similar/same problem called hypervigilance syndrome. It is likely that you may be having one of these problems. Your rheumatologist may like to consider giving you amitryptiline 10 mg or 25 mg daily for the control of this problem. I strongly recommend that you continue to be under the care of the same rheumatologist and take this or other medicines only with his/her advice.

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