Arthralgias and Nasal Inflammation

Abstract

A 46-year-old man was well until three months before admission to University Hospitals, when he began to experience fatigue, malaise, and transient knee, shoulder, and elbow arthralgias. The arthralgias were characterized by persistent dull, aching pain episodes associated with fleeting sharp pains lasting no more than one minute. He had two episodes of swelling involving the left knee and right elbow that were reported to be associated with slight warmth and mild erythema. The discomfort associated with the joint swelling was minimal and the swelling resolved after several days while he was taking six to eight enteric coated aspirin tablets daily. He saw his physician who obtained a uric acid level and a Westergren erythrocyte sedimentation rate (ESR). The uric acid level was normal but the ESR was 42 mm/hour (normal range 0–10). He continued to experience arthralgias despite salicylate therapy. He later received a nonsteroidal anti-inflammatory drug that decreased the severity of the arthralgias about 50 percent.