Patient: Wandering pain in joints all over the body for more than 10 years, the symptoms have worsened in the past 2 years, the original onset of 2 to 5 times a year, can be relieved by taking ibuprofen. It is related to exertion. In the past 2 years, the pain is almost every day, the joints are not fixed, wandering pain, the pain seems to be the tendons around the joints, sometimes one joint hurts, sometimes several joints hurt together, exertion is the cause, sometimes it is not related to exertion. I have had pain in both large and small joints. However, there is no obvious symmetry. In the past two years, when the pain was severe, the rheumatoid factor, anti-chain O and blood sedimentation were normal, and the blood and urine tests, uric acid and kidney function were normal. This year, whenever I had pain, I checked my blood sedimentation, rheumatoid factor and anti-chain O, all of which were negative. I have taken oral ibuprofen tablets, Cologne capsules and other painkillers. I also took herbal medicine for a year. The pain started again in the last year, and it is a wandering joint pain. Please tell Dr. Zhang: What kind of disease do I have? What tests do I need? What medicine should I use? I am looking forward to recovery! Thank you! Zhang Ting, Department of Rheumatology and Immunology, Changzhou Second People’s Hospital: Hello! I have read your medical history carefully. Wandering arthralgia, most commonly known as rheumatoid arthritis, is related to streptococcal infection, but you have been checked many times that the anti-streptococcal O is negative, which is not consistent with rheumatoid arthritis. I would like to ask you a few more questions: 1. Do you often have a sore throat or inflammation of the tonsils? 2. Which ones are the main arthritic pains? Have you had any pictures taken and what are the results? 3. Is there a difference between daytime and nighttime joint pain? If so, how long does it last and does it get better after activity?5. Does the pain ease or worsen after activity?6. Finally, thank you for your trust in me! Patient: Thank you, Dr. Zhang, for your reply in your busy schedule. I will answer your questions one by one 1, no frequent sore throat and tonsillitis attacks. 2, When joint pain is present, there are no obvious few joints that dominate. The joints all over the body have been painful. For example: the common people’s hook, it is difficult to open your mouth to eat when it hurts. Finger joints, shoulder joints, elbow joints, cross joints, and so on. 3, there is no significant difference between daytime and nighttime joint pain. 4, basically no stiffness in the morning, just can’t bend my fingers when in pain. 5, The more I move around, the worse my pain gets. As I said, my pain is related to exertion. Therefore, I don’t dare to move a lot during the day. I am even more afraid to move when I am in pain. I always feel like the tendons around the joints hurt when I am in pain, and I can always feel a particularly painful “point”, which I don’t dare to press when it hurts, but when I press this “point”, the pain is unbearable. 6, after doing heavy work, the muscles hurt, and the tendons around the joints hurt. I haven’t had my muscle enzymes checked. What are the items included? 7. I am a doctor and I am involved in testing. I’m a doctor and I’m in the testing department of the Leiting County Hospital of Traditional Chinese Medicine in Hebei Province. I am consulting for my sister. 8, my sister is very young, just 34 years old, in the family farming, since the disease, simply can not do farm work, rest all day and body pain, until now can not find out what disease? What is the cause of the disease? I am very anxious. Dr. Zhang, I really trust and thank you. I hope you will reply. Thank you again! Zhang Ting, Department of Rheumatology and Immunology, Changzhou Second People’s Hospital: Hello! Your sister’s medical history is more than 10 years old, because online medical search has certain limitations, such as not being able to do a detailed physical examination, medical history information is also limited, you are a test, also counted as a peer. In your medical history, you emphasized that “in the past 2 years, I have been having pain almost every day, and my joints are not fixed, and the pain is wandering. As I said, my pain is related to exertion. Therefore, I don’t dare to move a lot during the week. I am even more afraid to move when I am in pain. I always feel like the tendons around my joints hurt when I have pain, and I can always feel a particularly painful “spot”, which I don’t dare to press when it hurts, and when I press this “spot”, the pain is unbearable.” This may not just be joint pain, but it seems somewhat similar when you look at fibromyalgia in comparison, a condition where lab tests are negative for blood sedimentation, muscle enzymes, rheumatoid factor, etc., and there are 18 (or at least 11) pressure points on palpation. You can check the data or search online (I won’t list the 18 pressure points in detail here) about fibromyalgia, which is also an exclusive diagnosis, just like adult STILL disease, based on the exclusion of other diseases. You can give your sister a physical exam against the 18 pressure points. I am waiting for the results of your physical examination! Patient: Thank you very much Dr. Zhang for your guidance. I think I am really lucky to come across you online. I also found that my sister’s condition is too similar to the fibromyalgia you mentioned. What I want to ask is: You asked me to give my sister a physical examination of the 18 pressure points, but she has no pain when she is not in pain (like a normal person when she is not in pain), how can I do a physical examination? Also, I’m an examiner, but I’m illiterate in clinical diagnosis, so thank you again for your advice. I just looked up the treatment of fibromyalgia on the internet after reading your reply. Are there any side effects? Can you give me a suitable treatment plan? My sister has been using western medicine and Chinese medicine for more than 2 years. I think it must not be the right one. We have been treating it as rheumatism. So we are very anxious. We would like to use the “fibromyalgia” treatment for a period of time under your guidance, is that possible? Can you give me a treatment plan? We are really sick, but I believe that if we go to you, we will not be sick. I have just found a treatment plan on the Internet: can you take a look at it and see if you can use it? But I would like to get your treatment plan. I’m looking forward to it! Online treatment plan: Amitriptyline 10MG, which can be slowly increased to 20 – 30MG or aminocyclopentene (sulforaphane) 10 – 40MG depending on the situation, both to be taken once at bedtime. Cloxazone tablets 0, 2MG, day 3, Zhang Ting, Department of Rheumatology and Immunology, Changzhou Second People’s Hospital: similar is not the same as confirmed diagnosis. All drugs have their side effects. On the question of physical examination, pain is not equal to pressure pain. You can also do pressure pain test when you don’t have an attack, but the accuracy may not be as good as when you have an attack, you can try it. You are advised to: seek medical examination by a specialist at the time of onset. I understand your feelings, please be careful! Patient: I took my sister to have 18 pressure points checked, which were done without any of her joints hurting. 4 of the 18 pressure points had pressure pain. Left scapula, left elbow, both knees. What do you think? Is it possible to determine fibromyalgia? One more question: Is it possible to relieve the pain by rubbing the joint when it hurts? Or is it better not to move when it hurts? Zhang Ting, Department of Rheumatology and Immunology, Changzhou Second People’s Hospital: The diagnosis is not confirmed yet. Does your sister have symptoms such as insomnia, wakefulness, dreaminess, lack of energy and other sleep disorders and fatigue? If yes, it is more likely. It is recommended that you consult the experts at Peking Union Medical College or Shanghai Renji Hospital, which are more authoritative in rheumatism. Another painful time is recommended to rest, rubbing may aggravate the symptoms.