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Diagnosed To Have Osteoarthritis Of Hip. Has Knee Pain And Ankle Swelling. Diabetic And Hypothyroid. Reason For High CRP?

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Posted on Mon, 3 Jun 2013
Question: Hi,
My mom has positive RA factor and CRP is 8.2.
She was diagnosed to have osteoarthritis of hip. She has pain on her left knee and recently had ankle swelling for nearly 10 days. She is diabetic, has hypothyroid and also diagnosed to have osteoporosis.

1) Is it rheumatoid arthritis or any other type of arthritis?
2) Also, Please let us know the reason for her high CRP
3) Uric acid was 4.9 and urea at 36.2. Could it be gout?
doctor
Answered by Dr. Mayank Bhargava (1 hour later)
Hi XXXXXX
Welcome to XXXXXXX forum.

Let me explain your query one by one.

CRP and ESR are non specific investigations and high values generally indicates presence of active disease whether osteoarthritis or rheumatoid arthritis.
It could also be elevated in other organ associated disease such as ischemic heart disease, connective tissue disorder.

RA factor could be falsely positive or could also be a feature of rheumatoid arthritis.

Rheumatoid arthritis could be associated with positive and negative RA factor and for confirmation, your mother should go for Anti-CCP antibodies.

Rheumatoid arthritis is associated with pain in proximal interphalyngeal joint in hand, wrist ache back ache and neck pain while Osteoarthritis is associated with pain in knee, hip and distal interphalyngeal joint in hand.

Gout is associated with raised serum uric acid level (> 6.0 mg%) and is associated with pain in joint of big toe in foot.
Although few literature also favors that gout or joint ache could also be associated with normal serum uric acid.

You should consult with XXXXXXX medicine specialist/ orthopedic surgeon and should go for thorough check up.
She should also go for erythrocyte sedimentation rate (ESR), Anti-CCP antibodies.
Diagnosis of rheumatoid arthritis could be confirmed with positive Anti-CCP antibodies.

Treatment depends on exact diagnosis.
Meanwhile, she should take Glucosamine with diacerein, along with gastroprotective NSAIDs.
You should also consult with physiotherapist for assistance in joint movements.

Hope that helps.
Let me know your other query.
Take care,
Dr. Mayank Bhargava

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Mayank Bhargava (8 hours later)
Could elevated CRP be related to her hypothyroidism (she takes 25 mcg of the medicine, every morning)?

What is your inference with the current RA factor and CRP? Similarly uric acid and CRP?

ECG taken 2-3 months was also normal. Her BP is also normal. If you could zero in exactly for her, it will help a lot. ESR (2 hr stuff) was 35
doctor
Answered by Dr. Mayank Bhargava (2 hours later)
Hi,
CRP could also be elevated in hypothyroidism as most of the cases are due to Hashimoto's thyroiditis which is also an inflammation.
Presently CRP is raised and RA factor is within normal limits.
Still she should go for Anti-CCP antibodies to rule out Rheumatoid arthritis.
Best regards,
Dr. Mayank Bhargava
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Mayank Bhargava (23 minutes later)
Problem is zeroing in on exact problem? Whether it is due to arthritis, thyroid, kidney or heart? I had shared medical check results? Could you help or suggest which specialist to go for?
doctor
Answered by Dr. Mayank Bhargava (18 minutes later)
Hi,
I am not able to understand meaning of "If you could zero in exactly for her".
As it is non specific investigations, its very difficult to comment that which disease is causing high CRP.
You should consult with XXXXXXX medicine specialist/ orthopedic surgeon for expert opinion.
Sincerely,
Dr. Mayank Bhargava
Note: For further queries, consult a joint and bone specialist, an Orthopaedic surgeon. Book a Call now.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
Answered by
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Dr. Mayank Bhargava

Internal Medicine Specialist

Practicing since :2003

Answered : 1658 Questions

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Diagnosed To Have Osteoarthritis Of Hip. Has Knee Pain And Ankle Swelling. Diabetic And Hypothyroid. Reason For High CRP?

Hi XXXXXX
Welcome to XXXXXXX forum.

Let me explain your query one by one.

CRP and ESR are non specific investigations and high values generally indicates presence of active disease whether osteoarthritis or rheumatoid arthritis.
It could also be elevated in other organ associated disease such as ischemic heart disease, connective tissue disorder.

RA factor could be falsely positive or could also be a feature of rheumatoid arthritis.

Rheumatoid arthritis could be associated with positive and negative RA factor and for confirmation, your mother should go for Anti-CCP antibodies.

Rheumatoid arthritis is associated with pain in proximal interphalyngeal joint in hand, wrist ache back ache and neck pain while Osteoarthritis is associated with pain in knee, hip and distal interphalyngeal joint in hand.

Gout is associated with raised serum uric acid level (> 6.0 mg%) and is associated with pain in joint of big toe in foot.
Although few literature also favors that gout or joint ache could also be associated with normal serum uric acid.

You should consult with XXXXXXX medicine specialist/ orthopedic surgeon and should go for thorough check up.
She should also go for erythrocyte sedimentation rate (ESR), Anti-CCP antibodies.
Diagnosis of rheumatoid arthritis could be confirmed with positive Anti-CCP antibodies.

Treatment depends on exact diagnosis.
Meanwhile, she should take Glucosamine with diacerein, along with gastroprotective NSAIDs.
You should also consult with physiotherapist for assistance in joint movements.

Hope that helps.
Let me know your other query.
Take care,
Dr. Mayank Bhargava