Symptoms And Signs /Obsolete , Evergreen And New

CAN SYMPTOMS OF BODYACHE BE ORGANIC?

 O P Kapoor
Hon. Visiting Physician, Jaslok Hospital and Bombay Hospital, Mumbai,
Ex. Hon. Prof. of Medicine, Grant Medical College and JJ Hospital, Mumbai 400 008.

I often hear of this complaint - "bodyache" in most of the acute fevers. Though, it is complained of maximum in flue or dengue fever, most of the viruses like those causing viral hepatitis can also produce acute bodyache. In fact even other acute fevers like malaria can produce mild bodyache.

However, I want to discuss the symptom of "chronic" bodyache mentioned by the patient often to a consulting physician. Can this symptom be organic? Most of the time the patient has polysymptomatic complaints and bodyache has no special cause for it. In other cases it is functional complaint or related to depression, anxiety, lack of exercise, excessive smoking, drinking or tobacco consumption, insomnia etc. I am quoting below a few interesting patients of mine where this symptom of bodyache turned out to be very much organic:

  1. A few young female patients had a very low (nearly 0) levels of Vit D in the blood and a markedly raised serum alkaline phosphatase indicating the diagnosis of osteomalacia.
  2. Quite a few elderly menopausal females showed evidence of osteoporosis as the cause of bodyache, when DXA studies were done.
  3. Every year I pick up 2-3 young or middle aged patients (though more common in elderly) who have secondary deposits in the bones which I suspected from a routine SMA 12 report and ESR where elevated levels of LDH and uric acid were seen in addition to markedly raised ESR.
  4. On more than one occasion in a patient with markedly raised ESR, estimation of serum protein electrophoresis gave away the diagnosis of multiple myeloma.
  5. In two patients who did not have typical pains in the proxymal girdle area but complained of generalised bodyache, markedly raised ESR led to the diagnosis of polymyalgia rheumatica.

Finally, I have seen more than once, that patients with vague bodyache turn out to have positive HIV. Was it that these people had already established diagnosis of HIV and then developed functional bodyache, I do not know.



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