Joint Pain off and on for eight years

Dear Ask The Doctor: For about 8 years now, I have had joint pain in both my knees and both my shoulders. Also get swelling and fluid. Get a bad flare up about once a year but don't take any meds. I am 31 years old and doctors don't know what is wrong. First Fibromylagia, then Rheumatoid. Got a bad flare up about 3 weeks ago and had horrible pain in all joints but the worst was in my left shoulder. Got a MRI today and was told I have bursitis, tendonitist and a lumbar tear all in that one shoulder. Have not injured the shoulder at all. Why is this happening to me, I am too young to be having all this joint pain and issues. Tested for Rheumatiod and the RF test came out negative, what else could it be?! I have been to several doctors and no ne can give me a name for what I have.

Dear Jamie: First of all, I am going to begin by your recent MRI result: Bursitis, which is an inflammation of a bursa caused by repetitive use, trauma, infection, or systemic inflammatory disease. These synovial-lined sacs are filled with minimal amounts of fluid to facilitate movement during muscle contraction and they serve as a buffer between bone and muscle. First, you have to be patient because it takes quite some time for the improving of the symptoms as pain and inflammation. The conservative treatment includes: rest, avoid movements that cause pain, local ice or local warm compresses (which works the best for you), anti inflammatory medication (“Motrin”, “Aleve”), physical therapy and Range of Motion exercises. If after a while, the improvement is poor and you continue to have pain, I strongly recommend you re evaluation by an orthopedic surgeon and consider local injection. Regarding the joint pain “on and off” for the last 8 years, would be important to determine if it is a pain without heat or flushing (redness), if there is or not morning stiffness, if it is only limited to the knees and shoulders or you can feel the same kind of pain in other joints. Joint pain can be caused by a wide array of conditions from injury or disease affecting any of the ligaments, bursae, or tendons surrounding the joint. Injury or disease can also affect the ligaments, cartilage, and bones within the joint, leading to painful joints. Pain is also a feature of joint inflammation (arthritis) and infection. I strongly recommend that you make an appointment with a Specialist Rheumatologist so he/she may take a detailed history of your symptoms leading up to and associated with your joint pain. What activity(ies), if any, that you were doing when your joint pain began should be discussed. Aggravating and relieving conditions that affect the degree of your pain will also be important to discuss. After a thoroughly examination, further testing might be necessary, including specialized blood tests and  x-rays or other imaging studies. With this initial comprehensive evaluation it will be much easier to determine the cause and of course the best treatment option for you. The treatment of joint pain is directed toward the precise underlying cause. If the problem is an injury, the initial treatment often includes rest, cold applications, and anti-inflammatory medications. Additional medications for pain control may or may not be required. Gradual rehabilitation physical therapy may be needed. If there is a form of arthritis or other systemic disease causing the joint pain, antiinflammatory  medications may be recommended, followed by other medications directed at the cause of the arthritis. If there is disease of the bone, ligament, or cartilage, surgical intervention may be required.

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