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Joint pain, fatigue, stiff back, no swelling, positive rheumatoid factor, elevated WBC. Guidance?

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General & Family Physician
Practicing since : 2009
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joint pain and fatigueI am a 23 year old female, 5'10" and about 190 pounds. I've recently gained quite a bit of weight and am working to lose.

for the past 3 years I have been having joint pain in my hands and elbows primarily but also frequently in my hips. my back is often stiff as well. I have no known swelling. I've been to rheumatologists in the past because I have positive rheumatoid factor, although it is a low positive (17 last time). I also have elevated WBC which is a new thing for me.

I have no diagnosis and have not been helped by local doctors. I am often in pain. it comes and goes. I have mild iron deficiency but otherwise my bloodwork as of now is mostly normal.

xrays in the past, from about 2 years ago, showed suspected 'joint demineralization' in the hands but otherwise normal. no xrays since.

lastly, most of my issues with fatigue and general illness began when I was 11 after dealing with the epstein barr virus.

I am looking for guidance as to how to deal with the issues I am having. the nearest rheumatologist is 2 hours away. I may be worried over nothing and I don't want to waste theirs and my own time, but I often worry that something is wrong and I need to feel better. what would you recommend I do?
Posted Sun, 9 Sep 2012 in Bones, Muscles and Joints
Answered by Dr. Aparna Kohli 3 hours later
Thanks for writing in.
Its not that you're worried over nothing and in my opinion, you definitely need a rheumatologist's consult.
Your findings are definitely indicative of an inflammatory process in which most of your joints are involved. Also, unless you have not been eating well or are bleeding excessively during your period, there is no reason for you to have anemia.
High leukocyte count, anemia and joint stiffness with 'demineralization' on Xrays could be suggestive of rheumatoid arthritis or another autoimmune arthritis.
We would need to repeat a rheumatoid factor and also run another test called Anti-CCP (anti-citrullinated protein) antibody.
We would also need to repeat a Xray of the region where you have the most pain.
We definitely need to get this evaluated. We dont want you to get diagnosed at a time when it may become difficult to tackle the problem.
Hope that helps. Let me know if you have any more questions
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