Hello doctor,This is regarding my 64 year old mother-in-law. She has backache and general malaise. She has also had pain in both the knees for a while now. When climbing stairs or walking on inclined roads, she requires support. She experiences extreme fatigue roughly in the evening between 5 PM till 7 PM where she does not feel like getting up. We got some basic tests done. Her hemoglobin appears to be low and the ESR is elevated. Does this suggest an autoimmune disease? What kind of doctor should we consult and which tests would you recommend?
Hello. Anemia can lead to fatigue as well. Your mother's hemoglobin level is low and iron deficiency anemia could be suspected here.  Further work up is needed in the form of serum TIBC (total iron binding capacity), serum ferritin, and transferrin saturation assay to confirm iron deficiency anemia. If confirmed, Ferrous ascorbate tablet containing good elemental iron can be prescribed. ESR (erythrocyte sedimentation rate) can be high because of an inflammation or infection and it is not indicative of any specific disease. For both knee joint pain, osteoarthritis can be the possibility and according to the grade, a management plan is decided.  To investigate further, digital X-ray of both the joints, serum ANA (anti-nuclear antibodies) estimation, serum RA (rheumatoid arthritis) factor estimation can be done primarily. Check her serum calcium and vitamin D3 levels as well. These work up just now can be done as primary work up. You can consult an orthopedic surgeon with a specialization in joint and spine for your knee joint problem. For weakness, if needed, a physician can be consulted. In autoimmune diseases, a multisystemic disease involvement is present usually. For more information consult a hematologist online -->