A member presented a medical case:
Crazy cramping
Patient with a rare autoimmune disease ( relapsing polychondritis) with new onset worsening cramping of muscles over body worsening over time. Blood work wnl muscle relaxer of limited help
Close details
Patient demographics
Gender
female
Age
47
Ethnicity
Native American or Inuit
Occupation
Virtual teacher
Chief complaint or problem to solve
Muscle cramping includes diaphragm cuts off air. All area of body. 800 mg skelaxin 3 x day minimally helpful. On imuran and 55 mg prednisone stepping down from flare. Onset slow and increasing over two mos. racing pulse now present. No apparent triggers. Added magnesium, calcium, vit d supplements w no change in course. CBC and electro lights wnl within last week.
Case history
Past attempts to control RP have failed. Patient on way to Mayo in January. Patient has tried Epsom salt soaks, heat, stretching, quinine water, dietary supplements, eats nonprocessednto control cramps with no luck. No diabetes but asthma as a complication. Former smoker quit 25 yrs ago. Heart cath two years ago was 100% normal no lacks or narrowing. EENT scopes airway every 6 mos for narrowing no significant findings beyond inflammation. ENG eval of nerves to legs for numbness ( patient experiences neuropathy of feet for several years and had an issue with left foot drop that resolved two mos prior to cramps staring) all normal. Left hip has implant neurostimulator for knee injury pain sustained damage to nerves behind left knee in fall in military. Left cochlear implant due to deafness from RP. Cramps literally lock muscles into solid mass causing pain, falling, injuries ( depending I where cramp is) and inability to draw a breath when diaphragm is involved. Patient has come close to passing out with diaphragm cramps. Cramps increasing industry and duration and occur throughout the day. Can be result of position change or random.
Purpose of case discussion
Any help appreciated in any direction. Doctors stumped. Patient cannot wait 8 weeks with increasing difficulties.
Supplemental Materials

Dr. Alvin Wells
Internal Medicine - Rheumatology
5 doctors agree

In brief: RPC

As a rheumatologist, I have quite a few patients with relapsing polychondritis (RPC).
Patient is do respond to therapy but do require routine evaluations every 3-4 months. There are multiple drugs that may be used but this depends on clinical findings as well as laboratory and imaging findings. I recommend that you be seen by a rheumatologist.

In brief: RPC

As a rheumatologist, I have quite a few patients with relapsing polychondritis (RPC).
Patient is do respond to therapy but do require routine evaluations every 3-4 months. There are multiple drugs that may be used but this depends on clinical findings as well as laboratory and imaging findings. I recommend that you be seen by a rheumatologist.
Thank
1 comment
Dr. Clarence Grim
I would do a potassium challenge to see if she responds to a high K intake. If so she will improve rapidly in 2 weeks. I would do Chap 9 exactly for 2 weeks of the DASH challenge. The Na helps retain K and the high K speeds repletion. I use Kindle Book-13: 978-1-43914-059-8. Will improve in days if it works. Let me know. Check compliance by urine Na/K. If not lower than 1 then review diet.
Dr. Jovita Anyanwu
Internal Medicine
4 doctors agree

In brief: Severe symptoms

Despite immunosuppressive your symptoms are severe.
Consider Hospitalization for IV immunosuppressive. Consider adding Colchicine and follow up with Mayo clinic as planned

In brief: Severe symptoms

Despite immunosuppressive your symptoms are severe.
Consider Hospitalization for IV immunosuppressive. Consider adding Colchicine and follow up with Mayo clinic as planned
Thank
Dr. Amrita Dosanjh
Pediatrics - Pulmonology
3 doctors agree

In brief: Mgt

I would suggest an ultrasound of the diaphragm, and assessment of respiratory muscle strength eg MIP and MEP, cough peak flow.
A muscle biopsy or re biopsy may be helpful as well, in providing additional information.

In brief: Mgt

I would suggest an ultrasound of the diaphragm, and assessment of respiratory muscle strength eg MIP and MEP, cough peak flow.
A muscle biopsy or re biopsy may be helpful as well, in providing additional information.
Thank
Dr. Clarence Grim
Internal Medicine - Endocrinology
3 doctors agree

In brief: Cramps all over body.

First i suspect your potassium is too low and contributing to the muscle spasm.
Be certain the lab draws blood correctly to get an accurate blood potassium measurement. That is draw blood after tourniquet is off.

In brief: Cramps all over body.

First i suspect your potassium is too low and contributing to the muscle spasm.
Be certain the lab draws blood correctly to get an accurate blood potassium measurement. That is draw blood after tourniquet is off.
Thank
Dr. Pierre Moeser
Internal Medicine - Rheumatology
2 doctors agree

In brief: Not related

Relapsing polychondritis affects cartilage based structures like ears, trachea, part of the nose, etc.
Cramping muscles, which are not typical of autoimmune diseases, would be unrelated.

In brief: Not related

Relapsing polychondritis affects cartilage based structures like ears, trachea, part of the nose, etc.
Cramping muscles, which are not typical of autoimmune diseases, would be unrelated.
Thank
Dr. Reid Holtzclaw-swan
Internal Medicine
1 doctor agrees

In brief: PMR?

Autoimmune diseases can occur together. This could be polymyalgia rheumatica.
This is muscle pain, worse with activity. Please see your primary care provider for a work-up or referral.

In brief: PMR?

Autoimmune diseases can occur together. This could be polymyalgia rheumatica.
This is muscle pain, worse with activity. Please see your primary care provider for a work-up or referral.
Thank
Dr. Karen Dantin
Family Medicine
1 doctor agrees

In brief: Consider

Consider magnesium to bowl tolerance.
Probable deficient.

In brief: Consider

Consider magnesium to bowl tolerance.
Probable deficient.
Thank
1 comment
Dr. Patrick Connerly
Did you test vitamin D prior to treating? Many deficiencies take a long time to correct- might be worth checking now. I have had two pts. exactly mimic RP only to have sx go away when treated for vitamin D def. Ethnicity and occupation are also risk factors for Vit D def in this person.
Dr. John Moy
Podiatry
2 doctors agree

In brief: Refined oils

The patient is saturated with refined oils.
He has too much oil rich food in his diet such as fried foods, bread and butter. He should be on an oil free diet for 90 days which include no poultry, eggs and dairy. There should be no white flour and white sugar. Best starch will be Sweet or Purple potatoes and Brown or white rice. In two weeks, you will notice the change.

In brief: Refined oils

The patient is saturated with refined oils.
He has too much oil rich food in his diet such as fried foods, bread and butter. He should be on an oil free diet for 90 days which include no poultry, eggs and dairy. There should be no white flour and white sugar. Best starch will be Sweet or Purple potatoes and Brown or white rice. In two weeks, you will notice the change.
Thank
Dr. John Goldman
Internal Medicine - Rheumatology
1 doctor agrees

In brief: RP associated vasculitis

Certainly consider associated vasculitis with the RP.
Also might cnsider a magnesium deficiency or stiff man syndrome.

In brief: RP associated vasculitis

Certainly consider associated vasculitis with the RP.
Also might cnsider a magnesium deficiency or stiff man syndrome.
Thank
Dr. Saptarshi Bandyopadhyay
Internal Medicine - Hospital-based practice

In brief: Need to check electrolytes.

Diffuse muscle cramping could point to a separate problem - electrolyte imbalances (specifically hypokalemia) brought on by prednisone / steroids (due to their mineralocorticoid effect).
Given recent dose / trial of imuran and prednisone, I doubt this is recurrence or continuation of RP flare (that would have been knocked out by pulse of steroids). So, best to look for alternative diagnosis. Urine for electrolytes, Cr, & CMP would be a good start. A trial of heat (heating pad) would help narrow differential. If heating pad does not alleviate symptoms, then systemic condition (not muscle condition) more likely.

In brief: Need to check electrolytes.

Diffuse muscle cramping could point to a separate problem - electrolyte imbalances (specifically hypokalemia) brought on by prednisone / steroids (due to their mineralocorticoid effect).
Given recent dose / trial of imuran and prednisone, I doubt this is recurrence or continuation of RP flare (that would have been knocked out by pulse of steroids). So, best to look for alternative diagnosis. Urine for electrolytes, Cr, & CMP would be a good start. A trial of heat (heating pad) would help narrow differential. If heating pad does not alleviate symptoms, then systemic condition (not muscle condition) more likely.
Thank
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