Unexplained swelling and pain in knees and foot

Patient

Q: About 5 weeks ago, I began to experience some minor pain in my left knee, just above the knee cap. I did not sustain any injury. Over the course of three days, the area just above the knee cap became stiff and progressively more swollen. I ended up in the emergency room on a Saturday when I could hardly walk on it. X-rays, ultrasound showed nothing. The fluid was drained and tested for infection and gout. Neither one was present. At a follow up with an orthopedic doctor, an MRI was done and showed nothing. A small amount of arthritis was observed, but it was unremarkable. A second draining and a cortisone shot was given. While the swelling was diminished, the knee continued to be painful and stiff. 4 weeks later the right knee began to swell and the right foot and ankle as well. Blood tests have ruled out gout, psedogout, rheumatoid arthritis, lupus, Lyme disease, infection. Working diagnosis is serum sickness although I have no fever or rash. Predisone is helping the inflammation, but seems to be treating a symptom. Pain is diminished, but not gone and minimal swelling is still present. What else could this possibly be caused by?

Doctor

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