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Stiffness And Pain In Thigh. All Test Results Are Normal Except ESR Level. Now What Can Be Done?

Posted on Mon, 10 Dec 2012

Question: My wife was having stiffness and pain in her right tigh for which we saw a orthopadics last week & prescribed following investigations :
X XXXXXXX Pelvis B/L hips; C-Hemogram ESR; CRP; RA Factor; T3 T4; TSH; Anti CCP; 250 H Vit D3 Level.
All parameters are perfect except ESR (westergen) which is at 45 & the limit is <20 and Rheumatoid Factor is at 39.1 & the limit is <30.0.
After observations doctor said that this is the starting of Rehamutoid Arthiritis and advised following medication :
- Zerodol (to be taken for 10 days after dinner)
- Razo (to be taken for 10 days in morning empty stomach)
- Calcium tablets (to be taken for 1 month)
- Riconia (to be taken for 1 month)

Kindly advise whether the observations are appropriate and seriousness of the disease. Also, please suggest the way forward to the treatment.

Answered by Dr. Divya Agarwal (9 hours later)

Hi XXXXXXX

Thanks for your query.

The symptoms you have stated are not corroborative with rheumatoid arthritis.
The rheumatoid factor is showing a very low titer and ESR is a non-specific test.
The treatment suggested is basically anti-inflammatory medication and not the one we generally give for rheumatoid arthritis.

I suggest that you need to get her evaluated by a Rheumatologist as she has an early arthritis. Sometimes tests may come out negative initially. What she needs is a detailed clinical examination.
I would like to know whether she suffers from back or heel pain or whether she has a positive family history for these.

Do get back to me with the details.

Regards

Above answer was peer-reviewed by : Dr. Mohammed Kappan

Follow up: Dr. Divya Agarwal (2 days later)

Hello Dr. XXXXXXX

Thanks a lot for your reply !

Luckily she doesnt have any problem like back or heel pain, but one of her aunt (maasi) suffered from RA but her mother/father & brother are absolutely fine.

Regards//XXXXXXX

Answered by Dr. Divya Agarwal (3 hours later)

Dear XXXXXXX

Thanks for writing in.

I suggest that she may follow the medication prescribed to her for a few days.

If the problem resolves... good; if not then she may need further evaluation.
As I already stated that the medication prescribed to her is not the medication for rheumatoid arthritis.

Hope this helps. You can write back if you have any further queries; if not, please close this discussion and review.

Regards

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Above answer was peer-reviewed by : Dr. Prasad