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Finger joint pain, high ANA titer caused by thyroid, taking Advil. Early stage of auto-immune disorder?

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Orthopaedic Surgeon
Practicing since : 2000
Answered : 170 Questions
Hello Doctor,

I am a 58 years woman who recently experiece finger join pain and stiffness and ankle stiffness in the early morning. I went to see my pcp and have blood test done. The results showed negative RF, CRP and low ESR 13 but high XXXXXXX 1:1280 titer. He later referred me to see an rheumatologist. More test was done. The results were

negative results for
RF 7 (< 14)
CRP <0.2 (0.0-0.9)
antiCCP < 16 (<20)
DNA double stranded < 1 (< 4)
sjogren's ab <1.0 ( 8.0 (<1.0)

but with positive results with XXXXXXX titer 1: 1280 (1:40) with centromere A pattern
TSH 5.3 with TPOab 683 (<35)

The doctor said the high XXXXXXX titer caused by thyroid problem, ask me to do follow up after 3 months. However, I am still have this minor joint pain on my middle finger of right hand since taking advil 4x/day. I am afraid that I am in an early stage of auto-immune disorder disease and miss the early diagnosis and treatment.
My sister has RA for 13 years. I research thru internet and found high anti-centromere antiboy is associated with Crest symdrome or Primary biliary cirrhosis. What should I do next ? should I go to get second opinion or simply wait ? Please advise, Thanks !!

sorry that I forgot to put more lab results for the second test

ESR 27 (0-20)
Centromere antibody > 8.0 (< 1.0)
Posted Thu, 3 May 2012 in Bones, Muscles and Joints
Answered by Dr. Atul Wankhede 4 hours later
Thanks for posting your query.

Thanks for the intricate details of your tests. Your instincts might be right as it looks like an autoimmune disease of late onset.

But frankly I still believe in the appearances of physical symptoms. As you have mentioned you have a painful finger and ankle joint of recent onset with stiffness. Now to term it Rheumatoid it needs to fulfill the following criteria-

1. Bilateral presentation, that is pain should be present in same joints in both hands or legs.
2. More than 3 joints should be affected.
3. Small joints of hand and leg should be involved.
4. Morning stiffness as you have should be present for an hour in morning, and
5. There should be changes in x-rays.

If you don't fit in most of these categories then it could be just a minor osteoarthritic episode which might subside completely in a few days. After so many tests you must have realised that rheumatoid factor even if negative does not exclude rheumatoid arthritis.

In more than 70% rheumatoid arthritis patients RA factor is negative. But ANA(Anti-nuclear antibodies) titre is quite specific. You also have a family member who's suffering from rheumatoid.

In my opinion you should wait for some time for either the symptoms to progress or regress, before you take a second opinion or more tests.

Only time will tell wheather you need anti rheumatoid or anti thyroid medicines. Meanwhile you need to allow the inflammation to subside by taking antiinflammatory medicines, rest, hot fomentation and some exercises under a physiotherapist supervision. They also administer local ultrasonics to relieve pain. Follow up with the rheumatologist after 3 months.

Hope I answered your query. If you need more help I'm available for follow up.

Good day.

Above answer was peer-reviewed by
Follow-up: Finger joint pain, high ANA titer caused by thyroid, taking Advil. Early stage of auto-immune disorder? 11 hours later
Hello Dr. Thank you for your advice. I do have stiffness on both hands and ankels, but didn't last long(just few minutes) right after i exercise them before I get out of bed.

But joint pain only happened to the middle finger of right hand. I will take your advice to wait a while then go to have more test done.

Thanks again !!
Answered by Dr. Atul Wankhede 3 hours later
Thank you for your kind words.Do not forget the criteria of atleast one joint in hand needs to be swolen besides symmetrical arthritis. I would also like to add that the morning stiffness has to be present for at least an hour before maximal improvement to term it rheumatoid. I believe in our decision to wait for some time.
Wish you an early recovery.
Above answer was peer-reviewed by
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