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Having joint pain. Noticed swelling and stiffness in hands. Tested negative for RF. Any advice?

Dec 2012
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Answered by

General & Family Physician
Practicing since : 2012
Answered : 1704 Questions
I am 41 y.o. WF, 66" 147# with hx ongoing joint pain that comes and goes - primarily swelling and stiffness in my hands, XXXXXXX achy pain in my hands, wrists and feet worse in the mornings, late at night and after long periods of sitting. Recurrent pes anserine bursitis in my knee. Sent to rheumatologist for work up of possible RA - labs came back and RF, XXXXXXX are negative, sed rate is normal, C Reactive Protien is nl - only abnormality is a BUN/Creat ratio of 38.2 BUN 21 Creat .55. I have hx of GI irriation from high dose aleve use to tx cervical strain/inflammation post ACDF 18 mos ago. Would this BUN/creat ratio mean it possible I could have ongoing underlying GI issue/bleed? was treated with omeprazole 40 mg for 3 mos, but have not been on it the last two. CCP still pending on my RA work-up. Thanks!
Posted Mon, 18 Mar 2013 in Bones, Muscles and Joints
Answered by Dr. Nsah Bernard 2 hours later

Thank you for posting on XXXXXXX
It is quite surprising that your RF turned out negative despite your symptoms as they are clearly that of RA. Despite RF being negative this does not mean that RA is completely ruled out as sensitivity is positive in 50% of patients presenting RA. Another specific test to evaluate is anti-cyclic citrullinated peptide (CCP) antibodies (since still pending you just wait for it). Negative results does not exclude RA and you might be treated despite for RA irrespective of the test results but maybe after your doctor has ruled out completely other possible causes of your symptoms. Non the less they are other possible differentials of RA particularly acute viral polyarthritis, Rheumatic fever (elevated ASLO and other clinical considerations), psoriatic arthritis, polyarticular gout or calcium pyrophosphate deposition disease, and Creatinine level, it is not possible that you are having a kidney failure. High ratio signifies a possible dehydration and maybe a GI tract malabsorption syndrome is implicated.
An autoimmune condition might be responsible for both your rheumatism or rheumatic signs and your GI tract.

Hope this might be helpful and wish you a better health.
Dr Nsah
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