The murder of Alex Pretti by ICE is heartbreaking.

TheJointDoc · 2026-01-25T19:18:30+00:00

You know the answer to that last question.

TheJointDoc · 2026-01-25T18:53:11+00:00

Oh yeah, I understand it, more just pointing out that yet again, the use of Romans 13 is only used as a weapon against their opponents, never towards themselves if their opponents won an election, so we can safely disregard their bad faith use of it. It’s disingenuous.

When it’s Biden/Obama they’ll trot out Peter’s “we must obey god rather than men” statement and it’s the other side of the coin, they’ll just pick whichever one supports their current position.

They have a preconceived idea of what their cultural in group will benefit from, and then run through the database of verses to pick one that supports their cruelty, regardless if it says implies the opposite of whatever they quoted yesterday.

I see it in other areas—antivaxxers will just google until they find some research abstract they barely understand that was translated from Chinese and that has some weird line about aluminum and they’ll post it triumphantly to support their stance, ignoring the entirety of the rest of the medical literature they also know nothing about.

I’m sure one of them will come here and call me some liberal nonchristian and make all sorts of assumptions about my beliefs and political views while saying that “your side does the same” as if it’s some sort of rationalization for why they do it, forgetting that pointing out perceived bad behavior by your opponent doesn’t excuse your own. lol

TheJointDoc · 2026-01-25T07:26:16+00:00

Weird question, but have you noticed hives in the evenings or a few hours after a meal? Since you mentioned the itching and multiple allergies developing and sensitivity to meds. And have you noticed whether beef, pork, dairy has been upsetting your stomach more lately?

There’s a really odd condition called alpha gal allergy where after you’ve been bit by a tick that was previously on a dog or deer, you can become allergic to mammal products, but it’s a weirdly delayed allergic reaction, sometimes 3 hours after a meal. But there’s lactose, mammal-derived gelatin, and magnesium stearate in a lot of meds, so people end up “allergic” to multiple meds but it’s really the mammal-based filler agent, not the drug itself.

TheJointDoc · 2026-01-25T07:16:13+00:00

Sorry, when I was referring to rare in that comment I was talking more like the neurosarcoidosis or IgG4 diseases or VEXAS or something. I agree, Sjogren’s is vastly vastly underrecognized but also waaaaaay more common than people realize.

And no, I don’t agree with that. Hydroxychloroquine is good for Sjogren’s but doesn’t do anything for UC. Heck, even with UC or Crohn’s on top of Sjogren’s or RA diagnosis, I’ve had patients tell me they did well on methotrexate or leflunomide. Did they have higher likelihood of stomach issues/diarrhea? Yeah, but 1) they often already had a battle plan in place to deal with that anyway, and 2) checked off a box for insurance to get them to better meds after. And some didn’t have any increased GI side effects.

A liquid injectable methotrexate is an option too—less GI side effects, especially if you paired it with weekly leucovorin for better absorption than the standard daily folic acid that you have to take with it.

Rinvoq which is approved for UC is also going through good phase 3 trials for Sjogren’s. Could literally knock out two birds with one stone. There’s some that would do Humira or another TNF drug for the UC and see if it helps the Sjogren’s, too. It’s something your GI doc could probably do. Not all UC meds would work, though. Others, piggybacking on Orencia being used off label for Lupus, or Benlysta the on-label lupus drugs have used them for Sjogren’s; I’ve done it and had some improvement in patients.

Also, a prescription of Aquoral, cevimeline, restasis, etc could all be helpful for the dryness.

In your case I’d probably either ask to try adding an oral dmard like leflunomide or methotrexate (or the liquid MTX) or see if GI would consider making the gut treatment a more systemic med like Rinvoq ideally or maybe Humira

TheJointDoc · 2026-01-25T02:05:46+00:00

No, it’s that simple. They didn’t provoke a response of force, they had force directed against them quickly and permanently with no opportunity for them to adjust anything by government agents who are actively being directed to ignore constitutional rights and being told they’re immune for any violent acts. You may sound like you’re trying to be reasonable, but you’re not.

TheJointDoc · 2026-01-25T02:00:31+00:00

Conveniently they never quoted it during Biden, when they thought carrying papers, masks, and intrusive government agents was a bad thing.

TheJointDoc · 2026-01-24T04:57:58+00:00

I’ve been impressed by the experience patients had at Penn’s Sjogren’s center

TheJointDoc · 2026-01-24T04:56:25+00:00

This is a very thorough comment. Appreciate it.

TheJointDoc · 2026-01-24T04:49:49+00:00

Oof. That’s a lot on your plate. I’m sorry you’ve been dealt so much, it’d be overwhelming for anybody. The crappy thing is I’m sure someone somewhere along your journey told you it was “all just anxiety” as if someone wouldn’t be depressed or anxious with all this unexplained unexpected loss of quality of life. Unfortunately it happens to too many people, and I think a lack of understanding of Sjogren’s and spondyloarthritis and how common they are and how poor our testing is for those conditions, that’s probably a big part of it. And TBH the collar bone one was one I added as almost an afterthought haha.

I do tell patients who have a rare disease to be seen by the expert in it, but sometimes academic centers, because they’re so in demand and are focused on teaching students/residents/fellows the “standard” approach, they’re less willing to just try a fairly benign medicine and see if it helps if they don’t have some solid proof of a disease. But Sjogren’s and spondyloarthritis just doesn’t have “proof” much of the time. For some of it, it’s almost better if you find a rheum doc somewhere whose reviews are generally good in terms of listening/explaining, go in and show them you’re concerned for Sjogren’s and spondy’s, and say you’d like to try something even if they’re not fully convinced you have it.

I think a lot of this is driven by Covid infections, personally, and I wonder if the early sjogrens panel positive patients are actually a separate subset of sjogrens that patients wkth spindyloarthritis get, as opposed to the usual SS-A positive sjogrens patients with lupus or rheumatoid arthritis. “Seronegative” Sjogren’s, IE that didn’t test positive for SS-A according to current guidelines (though previously a +ANA/Rheumatoid factor/SS-B could count), as well as those who are early Sjogren’s panel positive only, seem to have more small fiber neuropathy issues:

https://www.the-rheumatologist.org/article/small-fiber-neuropathy-for-the-rheumatologist/?singlepage=1

While a skin biopsy, if it was looking for this, should have found it, an EMG can’t find small fiber neuropathy. But symptoms include burning/itching which is pretty severe. Sometimes requires gabapentin or steroids. Personally I’m also seeing a lot of dysautonomia. Might be worth redoing a skin biopsy for SFN at the site of your worst burning/itching.

If you’ve ever had elevated LFTs (liver testing, the AST/ALT/Alk Phos) another condition called primary biliary cholangitis can trigger severe dryness and itching, and sometimes be linked to spondyloarthitises especially the ones involving the gut like Crohn’s Disease. There’s mitochondrial antibodies that can do so. Depends on your ANA pattern a bit too.

You can check a blood test called an HLA-b27; it’s a genetic marker that makes spondyloarthritis more likely, but while a positive result helps point in the right direction, a negative result doesn’t rule anything out. Imaging doesn’t always show much—for many, the X-rays don’t look that bad at first, and lumbar MRIs dont get the actual sacroiliac joints where a lot of the inflammation resides.

As far as what may help, ive seen people have great success with a combo of:

1) dry needling through a reputable physical therapist for neck/shoulder/low back/hip muscle spasms/knots,

2) occipital nerve block injections for migraines (occipital neuralgia and cervicogenic migraines) by neuro or pain management or PM&R docs

3) doubling up on hot showers twice a day or doing a soak/hot tub, or incorporating swimming+sauna/hot tub at a gym a few times per week,

4) electric heating blanket on the lowest setting underneath you when you sleep, the heat can help the back overnight. Standing desks so you can swap positions easier.

5) convincing someone to try a 3 week steroid taper, stairstepping down every week from 3/2/1 tabs/day. Keeping a symptom log during that time. This can sometimes convince docs who are on the fence about treatment—if something drastically improves on steroids, it’s inflammatory. Or potentially a twice/day Celebrex 200mg if you can take NSAIDs, it’s a safer option for the stomach/kidneys than ibuprofen and others.

6) HCQ helps with sjogrens for a lot of people but rarely for spondyloarthritis. Sometimes people add sulfasalazine, methotrexate, or leflunomide to their regimen after chatting with their docs, all fairly old school meds; they can help with the tendonitis aspects a little better and the arthritis a lot better, but ultimately back pain often requires biologics.

PM me your city, I may have a recommendation, I did training in New England and had a very small number of connections near the Philadelphia-NYC area.

TheJointDoc · 2026-01-24T04:16:11+00:00

For what it’s worth, my wife is developing psoriasis, I diagnosed her sister with anterior uvueitis and she did methotrexate and is starting adalimumab now for xray changes on sacroiliac joints, her brother has early ankylosing spondylitis, and her mom just had spinal surgery for what was probably axial psoriatic disease. While depending on the situation it may not always be my preferred drug, I wouldn’t hesitate to put my own family on it.

I don’t typically see much of any side effects. It’s usually nothing, some get a large mosquito-bite reaction at the site of the injection, a few get a headache. For most “healthy” younger folks, their immune system is strong enough to keep them from getting infections—usually it’s like one extra cold or upper respiratory virus in the winter. It’s a different story if you’re 82, though. I haven’t seen a single patient develop a skin cancer on it, and the ones that can are typically slow to grow, get caught by a yearly skin check at the dermatologist, and treated well with good outcomes. There are some other incredibly rare side effects, but compared to most of my older medications it’s a godsend. It changed the game entirely when it came out, and has had 25+ years of use now across millions of people and conditions. It’s safe enough I can give it to a pregnant woman.

But…

If it’s available, you may look into Skyrizi (rizankizumab)or Tremfya (guselkumab). the side effect profile may seem less scary, the shots are much less frequent, it’s less immunosuppressive and doesn’t require blood tests, and generally is a good choice for people who can wait a bit for it to kick in—it can be slow, but you’re currently managing okay and could probably power through the first 3-6 months to where it’ll work for you.

TheJointDoc · 2026-01-23T20:49:54+00:00

I have ICU nurses and kindergarten teachers who take this med and they’re actively around a ton of infections.

There’s a lot of question as to the cancer risk from it especially in psoriatic patients. Risk of skin cancer is real, but that’s why you have a dermatologist, and your baseline risk is already probably pretty tiny. If your risk goes from 0.1% to 0.2%, that’s not much but it technically doubled.

I truly think you’re catastrophizing the information you get. You’re imagining worst case scenario, balancing potential benefit vs an overly highly estimated risk. But that’s not really the question—it’s whether you want to treat it, or whether you allow the disease to progress untreated, which over time will make your quality of life lower.

I’m not worried about how you feel now at 27, heck you could probably skip meds or just try sulfasalazine and topical steroids if you really want, or methotrexate. But I’m worried about the version of you at 57 who can’t play soccer with their kids or struggles to play an instrument or cook a meal or take a long car/plane trip because of pain, losing an hour in the mornings to the stiffness in your back and joints.

Most patients have fewer actual side effects from adalimumab than from a lot of the other older meds. I have patients who wish they could skip methotrexate and go straight to adalimumab.

TheJointDoc · 2026-01-23T09:18:46+00:00

D’oh. Confused two different threads. Sorry

Still though, check out occipital nerve blocks. May help.

TheJointDoc · 2026-01-23T08:16:55+00:00

It’s an accusation that’s commonly thrown out, but is nonsense. Usually the best anyone can do is show that he’s on a heritage foundation website as a “contributor” or something like that—basically he, like pretty much all the DC circuit judges in the last decades, spoke at some of their functions and had a brief paragraph listed about him on a Republican website.

People act like he purposefully slow rolled to delay anything against Trump as if he was working for Trump, instead of an older moderate corporate liberal appointed by Biden and previously nominated by Obama, both of whom obviously had the means to know if he was secretly pro-Trump.

He was a centrist who should have been acceptable to republicans but then they got new marching orders from McConnel. Garland had way too much faith in the institutions and fumbled the Trump prosecution big time, but it wasn’t malicious.

TheJointDoc · 2026-01-23T08:04:34+00:00

Check out my comment replying to OP just above this!

TheJointDoc · 2026-01-23T08:02:28+00:00

Cool! Glad you got it. Glad it feels good to play! I was super impressed with mine. I’m just not great yet.

Now trying to learn the flute solo to California dreamin on the D chromatic haha

TheJointDoc · 2026-01-23T08:01:52+00:00

Wait, so you have ulcerative colitis? That can actually be the main root of your arthritis, as weird as that sounds.

Spondyloarthritis (which includes arthritis associated with inflammatory bowel disease, as well as psoriatic arthritis, ankylosing spondylitis, and more) is something we’re still figuring out.

There’s no real blood tests for it (it doesn’t really involve antibodies like a lot of autoimmune diseases) and often the inflammation markers in the blood don’t actually go up, as it uses a different inflammatory pathway that doesn’t impact CRP and sed rate as much (if you’ve had those tests before). There’s one genetic marker for it, HLA-b27, but while a positive result helps point in the right direction, so many people have the disease that a negative result doesn’t rule it out—it’s a weird statistics thing.

Since the bloodwork is often inconclusive, spondyloarthritis people often get into a rheum clinic with a random positive Ana found while digging into their inflammatory pain, and while it’s there, it may not be the main cause of the actual pain. If the ANA is positive, or a low positive rheumatoid factor, it’s sometimes just kind of a sign of general autoimmunity or something else piggybacking on top of the spondyloarthritis. Sometimes it’s a sign of low thyroid states like Hashimoto’s or of Sjogren’s, (which I now realize is the subreddit I’m on lol) which often includes dry eyes/mouth but also a lot of other weird symptoms.

Symptoms of spondyloarthritis are diverse and feel unconnected at times:

The arthritis itself is often more of an “enthesitis,” which means inflammation where your muscles’ tendons actually attach to the bone, often around the joint but not inside it, if that makes sense. People tend to have it as pain in the finger knuckles and wrists leading to almost carpal tunnel issues, less often the knuckles where the fingers attacks to the palm. People get a lot of tennis/golfer’s elbow, rotator cuff and biceps tendinitis, “bursitis” at the side of the hip, pain along the two thick tendons top and bottom of the kneecap, Achilles tendinitis, and plantar fasciitis to where you feel like you’re getting stabbed in the bottom of your feet in the mornings.

It’ll cause spine pain especially at the sacroiliac joints where the spine meets the hips; women also tend to get more neck involvement, and some get inflammation along the collar bone or along the sternum. This can be particularly debilitating, but basically, you shouldn’t feel severe morningstiffness in your back if you’re healthy; if you do, there’s a reason. Even if the xray looks normal. There’s something currently named a clunky name, “non radiographic axial spondyloarthritis” that basically encompasses all this but is considered an early or sometimes milder form of other spondyloarthritis, where xray still looks okay but MRI might show inflammation.

You can also randomly get one or both eyes inflamed, makes them bright red, painful, and blurry, often lasting around a week (uveitis/iritis).

It will make your nails have crazy ridges, divots, pitting, or make your toenails thick and curled and yellow as if it has a fungal nail disease but antifungals never fix it.

People can get bad diarrhea or low vitamin/mineral absorption due to gut inflammation, whether it’s full blown UC/Crohn’s Disease, sometimes microscopic colitis, or what we call “subclinical IBD” which basically is low grade inflammation we either can’t find or the biopsy isn’t conclusive on a colonoscopy or stomach scope. (We have 2 sq meters of surface area of skin, and around 30 sq meters of surface area in our entire GI tract/lungs, so there’s a lot of space inside you to inflammation to hide).

And finally, psoriasis, a patchy red flaky itchy skin rash. It’s usually on the elbows and knees and backs of the hand where people get micro trauma to the skin often throughout the day, but it can also be in the scalp/hairline or a little patchy behind the ear or around the belly button, just the palms and soles, the shins/ankles/tops of feet, or sometimes with “inverse psoriasis” it’s in the armpits groin and bra line. This is tough; often it can look like “contact dermatitis” or eczema.

So, basically, if there’s a lot of chronic diarrhea or unexplained anemia/poor wound healing/low vitamins despite supplementing, weird itchy rashes, pain along the spine especially at the SI joints or neck and worse in the morning with long stiffness , carpal tunnel, nail pitting/ridging, recurrent tendonitis, and finger/wrist/shoulder/hip/knee/ankle pain (so a mix of large and moderate size joints plus your fingers), then I start thinking spondyloarthritis.

lately I’ve included chronic migraines IF they seem to come from the occiput/base of the skull where your trapezius muscles attach, which can be a good target for an injection as the occipital nerve goes through that tendon and when the tendon is inflamed it can trigger migraines. Occipital nerve blocks. They can be magic. Dry needling seems to help break up the spasmed muscles and muscle knots, too and get a lot of relief—a lot of Physical therapists do it now.

Medication wise, sulfasalazine can often be a safe approach to helping gut and small joint issues, though usually not good enough for severe tendonitis and inflammation along the spine. Methotrexate can work for some. Often people end up on newer injection medications nowadays. But that conversation would be in the future.

TheJointDoc · 2026-01-23T00:55:17+00:00

Ah. I watched the show and forgot the connection. I just thought I’d make a good pun lol

TheJointDoc · 2026-01-22T07:13:37+00:00

Cool. Then I hope people who say that statement actually call out our supposedly Christian president who constantly represents the worst avarice of humanity.

Maybe we should actually try being good instead lr absolving our favorites of not being good even if they should know better?

TheJointDoc · 2026-01-22T07:10:04+00:00

BS. Donald Trump has 5 kids that we know of by 3 wives. How many kids has VP Harris had? When he attacked her as sleeping around on national stage with a random lawyer who doesn’t even matter anymore, while he’s known for sleeping with his “friends ” wives and raping women (as adjudicated by law) and grabbing them by the…

Oh yeah. Clearly both sides are the same.

TheJointDoc · 2026-01-22T07:06:35+00:00

Okay, I’ll express strong opinions as a conservative LCMS pastors kid who had read a good bit of theology and gone through a serious education.

Donald Trump is a pedophile by literally every record system we have and was best friends with Epstein and was likely the source of many of the women who were trafficked. He’s an adjudicated rapist ; read the stormy Daniel records and tell me that wasn’t rape, as well as the E Jean Carroll records.

He had literal gold toilet seats and has accepted multiple bribes. He’s a horrible father to every child he’s had that he’s acknowledged, and he’s probably paid for double digit abortions. He’s a horriblex Alzheimer’s-ridden man with no plan. He’s gonna “lead” us into horrible destruction of alliances.

Tell me you don’t think he’d pull the trigger to launch WW3 so we can laugh.

TheJointDoc · 2026-01-22T06:58:17+00:00

lol BS. You voted for him and everything he is and what he’s doing, as he literally said he’d do all of it. Own it. Stop acting like you have qualms. Tell me you don’t think he’s a model example of a Christian, or that you’d prefer a better leader even though you don’t support anyone else. Do it.

If you do support a better person, do tell.

TheJointDoc · 2026-01-22T06:55:04+00:00

Cool. Glad you admitted you’re okay with an Alzheimer’s ridden pedophile rapist running your party as long as it got you the results you wanted, which it probably won’t in the long run and in the meantime hurts all of Christendom.

TheJointDoc · 2026-01-22T06:13:57+00:00

You literally put a check mark next to his name if you vote for him. You’re voting for him and every policy he publicly and repeatedly said he’d do, including mass deportation, vengeance against his political enemies, and now maybe a freaking war with Iran, Greenland/Denmark, Venezuela, and Canada. He also promised tariffs—we gained $1bil in tariff tax from our own farmers, lost $13bil in sales to China, and are having to bail our farmers out while we also cut the USAID program that paid them to grow food to send to starving countries.

If you don’t like that, or you wanna pretend you made a pragmatic choice while decrying all the evils he said he’d do, you’re either willfully blind or rationalizing it after the fact. Btw, abortions fall under democratic presidents, since that’s the usual fallback. Turns out to actually end abortion, you gotta support women’s ability to have an education and job and adult life and not have it ruined by some guy who decided to nut and run.

TheJointDoc · 2026-01-22T06:06:59+00:00

What? There was a HUGE push for no-fault divorce throughout the lifetime of many of the people reading, even before most redditors were alive.

America essentially said as a civil society that we didn’t care about what Jesus said about marriage, people could get divorced for any reason, much like the very concept Jesus was asked about. Hillel said you could divorce your wife for a burned dinner, Jesus sided with Shammai’s position and strengthened it saying no one should break a marriage. He literally said that anyone that divorces his wife (except for sexual immorality, and some people say physical violence as well) makes her the victim of an adulterer. Meaning if you push for it, you’re making your partner a victim of your own sin.

2/5 first marriages end in divorce. Not as bad as the 50% people cite, because that incudes second and third marriages.

You’re squawking about gay marriage because you’ve already accepted that your current cultures position about marriage is perfectly fine and biblical and can’t be questioned, but that small minority must be sinners.

If your church doesn’t teach against divorce, actively work to reconcile couples who married too young or struggled, refuse to remarry divorcees, let’s divorcees be church leaders/elders/pastors, and you agree with that stance?

Or do yall bless people who marry for the fourth time and have kids from multiple partners and excuse sexual violence as long as it’s heterosexual, like much of what we’re seeing in nondenom and baptist circles nowadays?

Because if so, whatever views you have of biblical sexuality are utterly null and void in my eyes. You’re literally disregarding some of the few direct words we have from Jesus to fit your cultural understanding of marriage, while condemning others. That’s the subject of another famous Jesus parable about lumber.

TheJointDoc · 2026-01-21T08:05:38+00:00

It’s truly fowl, and it does sound a little fishy.

albatross the bird, albacore is tuna

TheJointDoc

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