Total Body Ache

If I were to seek medical care, I wouldn't even know what to tell my physician.  I have global soreness.  Since the calves are the worst, I could attribute this to the treadmill, but it's not exclusively lower extremities.  There is a back component, which seems focused and a right shoulder pain that seems very characteristic of bursitis or tendonitis.  It responds to topical Voltaren when I apply it regularly.  I don't seem to have systemic illness, though my mood and disposition could use a reset.  Sleep, which had been responding favorably to targeted hygiene, has deteriorated, yet I don't feel depleted of energy.  I just have muscle soreness.

My first thought would be that my statin has caught up with me.  It definitely corrects my lab result and suspected intolerance, which has happened before, seems minor and difficult to confirm.  Still, omitting it for a week may be my best option.

Might it be polymyalgia rheumatica or polymyositis?  I don't have tenderness or weakness, even in the calves.  The distribution appears less proximal than the classic myalgias have.  Infectious?  No reason to think I might have exposure to brucellosis.  No rash to suggest Lyme.

Stay off the statin this week.  Voltaren to shoulder.  Naproxen if pain really needs medication or if I need relief to function.  Treadmill as my capacity allows.  Reassess. Even medical care if no progress.

Treating the Aches

In 2019 I developed an oligoarticular distal arthritis which lingered in some form until this day.  I took anti-inflammatories, splinted errant finger joints and tendons, squeezed the ball for platelet donations with my more functional left hand, and submitted to a variety of unrevealing testing conducted by a very capable personal physician.  It largely ran its course, though cycled, leaving me with no disability but a small residual discomfort in my right fingers.

Current aches are different, more consistent with the approach of threescore and ten years in just another week.  They distribute more axially, have not been migratory, persisted unchanged for months, and have more of a point focus in the part of my back least accessible to applying Ben Gay or similar atomic balm. I have a pleuritic component, my Hb has ebbed just enough for the blood bank to declare me ineligible to maintain my regular donations.  Other than being tired, which I attribute to disordered sleep, I do not feel systemically ill.  Other than a CBC, there has been no medical investigation, though I am due for periodic lab testing next month.  

As a more immediate pursuit, it would be better to have less discomfort, self-assessed at about a 2/5, more annoying by its persistence than its severity.  I took a naproxen, and plan to stay on a bid schedule this week.  I could ask my wife to goop my back with Ben Gay bid.  Not long ago I purchased a tube of Voltaren on sale, finding it useless on my hand though the suggested qid schedule could not be realistically maintained.  The current joint involvement, though mild, is widespread so internal therapy offers a better prospect than topical which may remain useful for the most bothersome areas.  Give it a go.  Stay on schedule.

Hands Hurt

Pauciarticular arthritis.  That's what it's called.  Maybe migratory arthritis.  While the last recommendation I wrote for a resident's fellowship resulted in a Rheumatology match, my own knowledge of arthritic syndromes has taken a major dip over my professional career.

I can describe history.  There is chronic recurrent low back symptoms, classically transient lumbago that is self-limited and responsive to naproxen.  Occasionally my ankles will hurt transiently and I have had an arthroscopy of my right knee about 15 years ago.  All large joints, mostly axial.  No effusions and really no objective exam features of rubor, tumor, calor, just dolor.

This is different.  When I retired I committed myself to a treadmill session, two days on, one day off.  I did a good job until the next back layoff.  Like most things I will make excuses not to do, it gets done most reliably when done first thing in the morning, which I did through my cruise to Europe last fall and into the winter, back permitting.  Then I started noticing some stiffness in the mornings.  Hands were most prominent but axial stiffness as well, pretty much every morning until late morning.  Being retired, I could go on the treadmill any time so I rescheduled this for late morning or early afternoon, with decent compliance if not otherwise occupied at those times.  Other than the morning stiffness, I experienced no constitutional symptoms but had some intermittent carpal tunnel numbness in the expected distributions, always transient.

Earlier this week I awoke with my left ring finger bent.  It looked like a boutonniere deformity and relocated with a snap to its usual position when I gently forced it.  Flexion dislocated this proximal interphalangeal joint again, only to snap back with gentle force.  A few more times back and forth and it stayed in place with mild discomfort.  The following morning it happened again and this time all the proximal interphalangeal joints on my left except the thumb were sore.  Distal joints were fine.  The metacarpophalyngeal joints were stiff and there was slight tenderness over the PIP areas but no swelling or redness.  By opening and closing my fist the stiffness went away.  The right hand seemed only minimally stiff but no pain.  Later in the day I took two naproxen tablets, which would be a full strength prescription dose.  It felt better in the evening.  This morning my left hand is almost back to baseline with slight joint stiffness.  However, my right ring finger became overtly inflamed at the MCP and DIP joints with less involvement of the middle finger DIP.  The MCP and proximal phalanx were far more tender than the left hand ever was and my middle and ring fingers could not make a fist.  Cold water helped, a blue gel cold pack helped less, and two naproxen had less effect on my right hand than yesterdays pills did for the left.  What gives?

The antecedent stiffness suggests rheumatoid physiology but the very transient nature on the left makes me think of other things.  Just have to give the right fingers a few more days, then reassess.