ZocdocAnswersWhat can cause moving joint pain accompanied by raised spots?

Question

What can cause moving joint pain accompanied by raised spots?

We've been to two different doctors and they've said he has gout (which I'm starting to doubt). One of the doctors didn't even look at him. But he has reoccurring joint pain (occurs multiple times a month) that moves from joint to joint. He sometimes has swelling, redness, and/or stiffness with whichever joint is hurting, but the kicker is before he has a "flare up" of bad joint pain he breaks out with these strange red spots on his ribs and sometimes arms. They start out red and raised and then turn purple and disappear. The one doctor that did examine him said that it was scars?? I will post a picture of the spots in the comments. I'm just really looking for advice on which direction to go with this "joint" problem or what it might be.

Answer

I'm not sure what kind of doctor you've been to, but it sounds like you should go see a rheumatologist. What you're describing is a polyarthritis (affects multiple joints) accompanied by a skin rash, which all in all sounds very rheumatologic to me. Possible rheumatologic causes include lupus, polymyositis or dermatomyositis, Still's disease, and many types of vasculitides. Sarcoidosis can cause joint pain and skin changes, though the skin changes are often over the shins, and can be accompanied by pulmonary symptoms (cough, shortness of breath). Viral infections can cause skin changes and joint pain, and psoriasis can affect both the skin and the joints. Other infections that can cause migrating joint pain and skin changes, including lyme disease, endocarditis, and rheumatic fever, though the latter two often cause people to be more overtly sick and to have fevers and malaise. As I said in the beginning, I'm not sure what kind of doctors you've seen and what kind of work-up has been done, but the best thing to do is take careful pictures of the rash (since it sounds like they disappear) and to try to see a rheumatologist when he is having the joint pain. If he gets joint redness and swelling, they can try to tap the affected joint and that will help determine whether this is in fact gout or something else.

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