A doctor asked his patient two strange questions that revealed a mysterious disease

The medication eliminated the cough and that was a blessing. But it did much more. He had pain and stiffness in his joints that had been there so long that he had begun to consider it normal. He thought this was how his adult body felt.

It started with a broken rib. Or at least that’s what made the 36-year-old doctor believe that something was wrong with her, she explained to the doctor. James D. Katz, the rheumatologist your friends recommended. Immediately after her daughter was born, 18 months earlier, she developed tos. At first it was only when he exercised, however, he could still complete half a marathon before her daughter was six months old.

Her record was still not as good as it was in previous races, but she was satisfied. After the race, the cough got worse. The violent paroxysms hit him so hard that he began to rib painespecially those on the right side.

After a few months when the cough persisted, he decided to go to the doctor. Ordered a bone scan in which he found what appeared to be pneumonia. Because the cough had lasted too long to be pneumonia, a tomography The same day. The scan clearly showed a broken rib.

They prescribed prednisone, then antibiotics. His lungs finally cleared. The cough, however, remained. You were diagnosed with asthma and started with a bunch of inhalers and a high dose of prednisone. He felt better immediately. It wasn’t long before he realized that the benefit was not coming from the inhalers; prednisone was miraculous. And he had been taking it, a lot, ever since. I knew it was too muchHowever, when caring for patients in the intensive care unit, something he did four or five months out of the year, he needed that high dose just to keep up with his life.

The medication eliminated the cough and that was a blessing. But it did much more. I had pain and stiffness in the joints that had been there so long that she had begun to consider it normal. He thought this was how his adult body felt. But with prednisone, the pain and the terrible stiffness disappeared. She was a doctor; he knew taking prednisone this way would hurt him. It could provoke you glaucoma, diabetes, osteoporosis e arterial hypertension. But every time he cut back on the steroids, the pain, stiffness, and cough would roar back. Right now, she told herself, taking that medicine was the only way she could feel normal. So he finally decided to see Katz.

James Katz was a research physician at the Institute National Arthritis and Musculoskeletal Diseases and Skin at the National Institute of Health in Bethesda. After hearing his patient’s story, he left the exam room to give her a chance to change into a hospital gown. While he waited, Katz considered the possibilities. When you first heard that you had joint pains that were resolved by prednisone, the specialist thought you probably had rheumatoid arthritis (AR). It was one of the most common inflammatory joint diseases in women her age and could sometimes affect the lungs. But i needed extremely high doses of prednisone to control his symptoms, and that was generally not necessary to treat RA, which was generally exquisitely sensitive to the anti-inflammatory properties of steroids. Most RA patients could be managed with five to ten milligrams of prednisone. She needed ten times more. NoKatz decided, this was probably something else.

At the top of his new list was a rare disease formerly named Churg-Strauss syndrome, now known as granulomatosis eosinofílica con poliangeítis (GEP). This is a disease that does not affect the joints, like AR – but from blood vessels. A vasculitis how the GEP is dangerous because the affected blood vessels can be anywhere in the body. PEG often begins in the lungs, often in patients with asthma, but can then spread throughout the body. But patients with PEG tend to have high levels of eosinophils, the white blood cells that drive disease. Hers were normal. And this syndrome usually causes more muscle pain than joint pain. So it didn’t fit very well.

Then he gently pressed on the outside of the knee joint.  If there was any fluid there, it would appear in the only space left, as a small swelling on the other side of the knee, the so-called bulge sign.  Sure enough, there it was.  Interesting.  There was inflammation somewhere in the joint.  (Shutterstock)
Then he gently pressed on the outside of the knee joint. If there was any fluid there, it would appear in the only space left, as a small swelling on the other side of the knee, the so-called bulge sign. Sure enough, there it was. Interesting. There was inflammation somewhere in the joint. (Shutterstock)

While the doctor examined the young woman, he paid special attention to her joints. If you had any signs of inflammation there, any redness, swelling, or fluid in the joint space, it would make the PEG a diagnosis even less likely. His knees looked normal, not red, not swollen, but they were quite tender. He made her stretch her legs and then pressed gently but firmly on her right thigh, a couple of inches above the knee, and moved his hand up her leg until she reached the ball joint. The knee joint space extends to the thigh, so if there is a small amount of fluid, it can be bypassed unless it collects in the joint. He found no fluid.

Then he gently pressed on the external face of the joint knee. If there were any liquid there, it would appear in the only space left, like a small swelling on the other side of the knee, the so-called bulge sign. Sure enough, there it was. Interesting. There was inflammation somewhere in the joint. If it was on the smooth outer surface where the joint was attached, known as synovial, so it was probably AR. But what if it was in the cartilage that cushioned the joint? Later pressed a point on his chest where the cartilage connects the ribs to the sternum. The patient jumped back in pain. “I didn’t even know it hurt there”He exclaimed.

For Katz, these two discoveries suggest a very rare disorder, a disease that causes inflammation and eventually, cartilage destruction. “Have you ever felt pain in your ears when wearing a hat?” I ask, “Or when you fall asleep on one side only?” The patient was surprised. No one had asked him those questions. Yes, he replied. “And did your nose ever hurt or red when you wore sunglasses?” Once again, she was in awe. Yes. Often. What the hell could that mean? She was a doctor, a specialist in intensive care and infectious diseases, and had never heard of any of these symptoms.

What makes RP particularly difficult to diagnose is that there is not a single blood test to confirm the diagnosis.  And even the images may not be noticeable until the disease is advanced.  Most patients should be diagnosed based solely on the symptoms they experience and what the doctor finds on the exam.  (iStock)
What makes RP particularly difficult to diagnose is that there is not a single blood test to confirm the diagnosis. And even the images may not be noticeable until the disease is advanced. Most patients should be diagnosed based solely on the symptoms they experience and what the doctor finds on the exam. (iStock)

For his part, the doctor was sure that she had something called relapsing polychondritis (PR), he told the patient. PR is a autoimmune disease in which the patient’s white blood cells attack parts of their own body, in this case, cartilage. The patient was amazed. She had learned about PR in medical school, of course. The key symptom to look for, she and most doctors had been taught, was a very swollen and red ear. However, the earlobe will look normal because it does not have cartilage. That or what is known as a saddle deformity, where the bridge of the nose sags due to the destruction of the cartilage there. It turns out that these classic symptoms are seen in only half of the patients diagnosed with PR.

What makes RP particularly difficult to diagnose is that there is not a single blood test to confirm the diagnosis. And even the images may not be noticeable until the disease is advanced. Most patients should receive the diagnosis based solely on the symptoms they experience and what the doctor finds on the exam. Because this patient had episodes of cartilage inflammation (in the ears, nose, chest and knee) that improved with steroids, met the diagnostic criteria for the disease. Once convinced of the patient’s diagnosis, Katz started the patient on a regimen of immunosuppressive medications.

Looking back, the patient recognized in herself something that she often sees in her patients: the negation. There was no outward sign of the pain he was feeling in his body: there was no redness, no swelling, just pain. And all the tests done to find one autoimmune or inflammatory disease they had been normal. It was clear to the patient that there could be nothing wrong with her, that it was all in his head. The facts of his illness –cough that she was violent enough to break a rib, her need to large doses of steroids to get out of bed — they mistook her for a doctor, so she ignored them.

Received the diagnosis six years ago. It took him months to control his disease and even now he has to take a long list of medications every day. Due to his diagnosis, he changed the course of his career. Now she cares for patients like her who are living with this little-known and often devastating disease. And his research is focused on improving what we know about how to diagnose and treat it. In this way, he hopes, patients will no longer suffer for years thinking that everything must be in their heads.

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Reference-www.infobae.com

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