A 40-year-old man presented with the following symptoms:
Swelling in ankles, knees, then extended upwards to wrist and fingers. It started with pain then fever for two days with the pain in joints. He took a painkiller injection for fever and pain. Pain is also in all the joints that were injured after several falls that he had over time.
Stools were not regular and he was constipated during the acute illness.
Thermals: He is not chilly and can stand average hot weather.
Now he is not having any pain at rest but has pain worse on movement.
He had pain in the chest which was throbbing. Pain was at the sternum and he had this pain after chronic cough from inhaling smoke when his house burned down. He was exerting himself to move to a new house three years ago.
No issues with his food, takes balanced meals.
Was vaccinated 9-8-2021
Stools: He has diarrhea at the moment because he took Colchicine thinking it was gout.
Sulphur 30c om x 5 days then every other day for 10 doses.
Arnica 30 c every 3 days x 10 doses.
My repertorising at that time included gouty because he actually has a past history of gout with a raised uric acid.
Blood was taken on the same day for arthritis studies and the abnormal parameters are here:
ESR, very slight increase to 12, normal is below 10
CRP is 10.1 this is quite high
Uric acid is normal at 0.39mmol/l
Total white blood cells normal but monocytes are at 16.9 which is high, should be below 10.
ASOT is normal. That means no rheumatic arthritis
ANA is also normal, SLE marker negative.
After sulphur he broke out in a rash which was very itchy, and he recovered without other interventions.
I gave Arnica as well because of his falls as well as the trauma from the fire that destroyed his house. I checked for emotional issues but he says he has none from the fire.
From the blood test which showed raised monocytes, he probably had a viral arthritis which turned chronic maybe from the suppression caused by painkillers. In my practice I find a lot of post dengue and post Chikugunya cases which turn chronic and develop joint pain. If this went on for a few years, it may become autoimmune, and the blood tests would indicate the same.
Cases like this where a viral disease ends up causing chronic symptoms are often seen. One has to be alert to the possibility, and careful history taking will be needed with a particular mention of infectious diseases, especially in areas which have endemic viral diseases. For example, joint pain is common in Chikugunya and Dengue. Other viruses which cause long term symptoms are the Herpes group of viruses and this is becoming more frequent with the latest pandemic and its so-called solution.