If had a tough case of severe inflammation and pain of a patient's Left wrist and Forearm. 88 yo male, healthy for age. It was initially treated in the ER as Cellulitis => didn't respond. It responded very well to Prednisone 50mg. It was fine on 25mg Prednisone. When the prednisone stopped it returned in 3 days. Prednisone was restarted on June 1, 2015. Features: - severe pain. - CRP 149 - now has thrombocytopenia - inflammatory markers worsening despite WBC now normal. - dramatic response to prednisone (swelling, inflammation) pain seemed to linger quite a bit. I referred the patient to rheumatology. This patient has a past medical history of Giant Cell Arteritis / PMR (in 2005)(stable on Methotrexate 15mg /week rally since then). His xray from April 6th (when it all started). ER Nurse's report. The first time, I would concur that the swelling eventually reached his elbow. On this second swelling, it started in the hand/wrist and had only proceeded 1/2 to his elbow before the second round of prednisone. To top it all off his wife just fractured her hip, getting surgery tonight. He's going to see a rheumatologist in 2 weeks. Plans: Probably will do ... (1) Workup for CPPD (Pseudogout) - he could be having severe gout like attacks [CPPD] Low magnesium levels in the blood (hypomagnesemia) Some causes of excess calcium in the blood (hypercalcemia) An overactive parathyroid gland (hyperparathyroidism) (2) Acute Calcific Tendinitis http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2654957/ - I kind of this it might be this ! Labs: PTH, Vitamin D, Serum protein electrophoresis, calcium, magnesium, albumin, ferritin, Repeat ESR, CBC, CRP. ------------------------------------------------------- Thinking about .... MRI wrist and forearm - obscure tumor ? (probably wont help) Bone scan ? (probably wont help) Ultrasound of wrist and forearm tendons ... inflammation ? (might do this). == Research == Discordance between erythrocyte sedimentation rate and C-reactive protein measurements: clinical significance. http://www.ncbi.nlm.nih.gov/pubmed/18078625 Rheum and Malignancy http://www.uptodate.com/contents/ma...MUSCULOSKELETAL MANIFESTATIONS&anchor=H16#H16 Any suggestions Graham, this has been a tough one.