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Stiff joints, pain in arms and hands. RA factor, ASOT, uric acid, ESR normal. Panadol advised. Do I have rheumatoid arthritis?

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Orthopaedic Surgeon
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My joints are stiff especially in the morning and there is pain on my arms and hands for around two months already. I need to constantly move my fingers and arms to ease the stiffness. I took a blood test and the results are normal. The RA Factor, ASOT, Uric Acid, C-Reactive Protein, Calcium, Phosphorus, ESR and ANF all are within the reference range. Is there a chance that I still have rheumatoid arthritus even though the results show otherwise? Are there any exceptional cases? If I do not have arthritus, are there any possible causes? My doctor just asked me to take Panadol.
Posted Fri, 15 Jun 2012 in Arthritis
 
 
Answered by Dr. Sathyadharan Panneer 2 hours later
Hai,

Thanks for writing in.

Though the tests done so far are all normal, it is still possible that you might be suffering with Rheumatoid arthritis (RA) or Seronegative polyarthritis.

Diagnosis of RA is mostly clinical. Since your symptoms of early morning stiffness, involving small joints of hands are towards polyarthritis, I cannot rule out RA yet as 25% of patients RA factor can be negative.

Anti-citrullinated protein antibody (Anti-CCP) test carries more significance than RA factor in such cases. Anti-CCP can also help in predicting your prognosis; also it can be detected more early than RA factor. Even Anti-CCP can be negative in about 2-5% of RA patients.

So if I were to be your treating doctor, I would advise you to get Anti-CCP test and refer you to a rheumatologist for treatment using non steroidal anti-inflammatory drugs like Indomethacin as well as Disease-modifying antirheumatic drug (DMARD) like hydroxychloroquine. Discuss with your treating doctor.

I think the aforementioned drugs will help you in alleviating the pain and also the progression of the disease.

Hope this answers your query. Let me know if you have any further queries.

Get well soon,
Regards.
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Follow-up: Stiff joints, pain in arms and hands. RA factor, ASOT, uric acid, ESR normal. Panadol advised. Do I have rheumatoid arthritis? 6 hours later
Thank you for your fast response!

A few toes of my left feet has pain and stiffness also.

I started to take Caltrate 600mg (Calcium Carbonate 1500mg equiv to 600mg of Elemental Calcium with 200UI D3) and D3 (400UI) around 2 months ago daily.

Is there any chance that the intake of additional calcium will cause this?
 
 
Answered by Dr. Sathyadharan Panneer 2 hours later
Hi,

Thanks for your query.

1. Calcium & Vitamin D3 won't cause bone pains. But if your bones were too low in calcium for longer time and you start Vit.D3 therapy, calcium entering the bone also draws with it additional fluid. This additional fluid can build up pressure inside your bone and cause temporary pain.

2. It can also be part of RA (Rheumatoid Arthritis)/ Seronegative polyarthritis.

So, it is not a contraindication to stop your Calcium & Vit.D3 supplements as the current dosage is rightly balanced. Rather it indicates that you have to continue the therapy.

Hope I have cleared your doubt.

Get well soon.

Regards.
Above answer was peer-reviewed by
 
Follow-up: Stiff joints, pain in arms and hands. RA factor, ASOT, uric acid, ESR normal. Panadol advised. Do I have rheumatoid arthritis? 3 days later
Thank you for your reply!

I have an appointment with a rheumatologist in XXXXXXX to do further check up. One last question. If the blood test of the Anti-CCP comes out negative, are there any more tests that I can take to further identify the cause?

Currently, I do not have swelling of the joints.
 
 
Answered by Dr. Sathyadharan Panneer 1 hour later
Hi,

Thanks for your query.

ESR (Erythrocyte Sedimentation Rate), CRP (C - reactive protein), S. Uric acid, RA factor and ANF (Anti Nuclear Factor) have already covered most of the causes for inflammatory arthritis.

In your case, even if Anti-CCP comes out negative, if the findings in clinical examination correlates with the disease pattern, your doctor might start you on a trial of NSAID'S / DMARD'S.

Performing tests without sufficient clinical evidence is not useful.

HLA-B27 for Seronegative polyarthritis, Synovial biopsy of involved part, X-ray of hand/ wrist can also guide us in confirming the disease.

Discuss with your treating doctor.

Get well soon.

Regards.
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