- CASE FILE
24 yr old, inflammatory arthritis in one MCP joint, all test are negative, no family history, dietary issues (gluten & dairy) but no IBD
ABOUT THIS CASE FILE
I'm a 24 year old female with inflammatory arthritis in one MCP joint on my left hand that appeared out of no where and the cause hasn't been established. In 2016, I had consumed beer and broke out into a bad eczema rash which was treated by steroid cream. At the time I didn't know it was the beer but after 3 months without it, I had two beers and woke up the next day with the same rash again which made me stop drinking it. About 2 years ago (late winter 2017), I noticed I was not processing gluten containing foods well (bloating, diarrhea, etc.). I thought it was possibly the bread I had in my apartment but when I had bread from a restaurant, I noticed the same thing. After this initial observation, I began getting sick off of pasta, crackers, pretty much everything that contained gluten. When I took gluten out of my diet, I felt better but I began eating it again to go through a series of testing for Celiac's disease (both blood test & biopsies) which all came back negative. I was also ruled out for IBS or IBD because I could handle all other food groups for the most part. In Nov. 2017, I drank a glass of milk and vomited shortly after (I had been drinking milk my entire life with no problem). When I tried again a week later, the same thing happened. Interestingly, I can eat cheese no problem. Several months later in May 2018, I noticed swelling in my middle left hand MCP joint and after seeing an orthopedic and now a rheumatologist, I've been diagnosed with inflammatory arthritis in Jan 2019 due to erosions of my joint present in an X-ray in Jan 2019 and were also present in my original X-ray in May 2018. After diagnosis I started with Naproxen (2 x 500mg) a day and noticed after a week on the medicine that I was passing blood and my pain was much worse on the medicine. After stopping the medicine, the blood was no longer present. I then tried methotrexate but at 20mg once a week, pain and stiffness of my finger was still present and my blood test still showed I had inflammation and high iron levels. I tested negative for the hemochromatosis gene due to the location of the swelling (commonly seen in middle MCP joint). My rheumatologists next thought was maybe I have arthritis associated with IBD due to my chronic diet issues. I also showed mild inflammation of my colon from a colonoscopy in March 2019. After getting off the methotrexate and seeing a GI specialist I was told that my symptoms seem more consistent with small intestinal bacterial overgrowth which I tested positive for and that my arthritis is a separate issue. I was prescribed rifaximin and collected a stool sample that showed I had normal inflammation levels. I have been given diclofenac gel due to the localization of the inflammation but I still suffer from the same side effects of the naproxen and will pass blood if I use the amount prescribed (4g x 4 times a day) and have been told the bleeding is not due to non-steroidal anti-inflammatory drug but rather hemorrhoids. I currently have no reasons for why I have arthritis in one joint or what is causing my body to attack itself. I have no family history with any of these conditions and doctors seem to think these problems are separate.