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How Can Rheumatoid Arthritis And Rheumatic Fever Be Diagnosed?

Posted on Wed, 5 Feb 2014

Question: Thanks for the reply Dr XXXXXXX We met. Dr.JMK XXXXXXX nuerologist (one of the experienced here at hyderabad). He ruled out any critical condition. RA, Uric acid- negative. So possibility of Rheumatoid is also less. but last time ASO was positive (before 40days), but he didnot take any medication. Does it cause severe pain in thumb (after 40 days)? He could not use his thumb to hold any things, even a small paper/book. Hemoglobin was high 17.2-17.4 (last two months- 3 times were checked in between). Does this have any correlation with it. He stopped pregabalin also, He is high pain now, melatonin, as you have said is fine, but its a better option (In my view) than any addictive painkillers. Please correct me if i am wrong somewhere. He could not get sleep regardless of pain (present or not), Any natural way available. Regarding T4 (little high)-does it has any role?? We met one RA specialist. He said about Rhematic profile or something, could not recollect full. I want to know other important tests to check rheumatoid... Thank you in advance.

Answered by Dr. Dr. Prasad J (3 days later)

Brief Answer: Rheumatoid arthritis is a clinical diagnosis... Detailed Answer: Hi, Rheumatoid arthritis and rheumatic fever are both diagnosed clinically. Laboratory test is only used to support the diagnosis. 1. Since he has no skin lesions, heart ailments, recurring fever it is unlikely that he has rheumatic fever, though a single ASLO titre was positive. He can repeat the ASLO titre and confirm the values. 2. Rheumatoid arthritis generally affects larger joints. Distal joints of fingers and toes are also commonly affected. I don't see any such joint affliction from the history provided. Therefore there is less suspicion about rheumatoid arthritis. If his ESR value, C-RP value, RA factor and repeat ASLO titre are negative, then you need not be worried about both rheumatoid arthritis or rheumatic fever. 3. Painful thumb may be part of the complex. You can discuss about the fibromyalgia if his doctors are unable to find a cause. It can be treated in consultation with rheumatologist +/- neuropsychiatrist. 4. Melatonin has potential to make his sleep well. However I don't think it will reduce his body aches and numbness. 5. Pregabalin has helped many patients with chronic pain. May I know the reason why he stopped taking it. If there is no problem, I would advice him to continue it. 6. A little high T4 is not significant when TSH is normal and he has no other symptoms of hyperthyrodism. In short, discuss about fibromyalgia when you consult the specialist again. Perhaps it can be related. I would restart pregabalin if he has no problems in taking them. He can consider melatonin after the next consultation. Hope this helps. Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Prasad J (1 hour later)

Thanks for the reply, It was more informational. We will consult first as you have mentioned,,, Only ESR ans ASO were positive last time,, But a small nodules (just2-3) occur inside the skin in random places like leg/hands. Last time one physician said it might be rheumatic nodules are sth? but he was bit skeptical. Does it be Lupus (mild)? but he don't have skin rashes or something. But i have read about Lupus like 1. "Self antibodies block small veins and cause small lesions(Vasculities)". 2. Antibodies against their peripheral nerves, can cause numbness and weakness in the feet and hands. 3. Feelings of confusion, fatigue, memory loss, and difficulty expressing their thoughts. Can cause frequent forgetfullness, mood swings. Difficult concentrating and vision problems. My brother has small lesions (may be point 1) numbness and weekness (may be point 2) and irritation, forgetfullness, fatigue and vision problems (may be point 3). He could not see bright light /under Night light (Headlight)- He says its full blank when sees any of this light. He could not drive bikes at night, for vision we checked with opthal Dr. thoroughly, but no probs, he said. But still needed we can go for Rod cells and cones cells number measurement Please guide us in this regard. Thanks in advance XXXXXXX

Answered by Dr. Dr. Prasad J (18 minutes later)

Brief Answer: Lupus is based on blood tests... Detailed Answer: Hi, Lupus and autoimmune antibody condition is based on measurements of antibody on blood tests. As a clinician I would not label a person with autoimmune antibody illness without sufficient laboratory evidence. A person with lupus would have a positive ANA; similarly a person with rheumatic fever would have positive ASLO titre. That being said, not all person with positive ANA and ASLO is diagnosed as autoimmune antibody condition. I hope this is clear to you. In your brother's case, though there are features similar to lupus, without a positive ANA, I wouldn't arrive at lupus as a conclusion. I hope with this answer you have better information to talk to the specialist. I will be glad to assist you further if needed. Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar