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Suggest treatment for aching muscles and increasingly painful joints

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Posted on Mon, 18 May 2015
Question: I was referred to a rheumatologist for a positive ANA after seeing my PCP for aching muscles and increasingly painful joints. I've had a bunch of extra blood tests run. Most results are in, but I don't have a follow up for 3 weeks. My ANA titer is 1:640, my anti-ccp is 21 u/ml and my crp is 0.9. All other tests are within normal range listed by test. All my research points to rheumatoid arthritis. I am still a tad concerned about Lupus because I have photosensitivity and get mouth sores and blue toes, but other Lupus screening tests are all negative. Any insight? I'm a 35 y/o female.
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Answered by Dr. Naval Mendiratta (50 minutes later)
Brief Answer:
? Is it lupus

Detailed Answer:
Good evening

Thank you for writing on health care magic

Well, considering the symptoms you have of oral ulcers, photosenstivity, Blue toes( ? Raynauds) along with myalgia and arthalgia along with such strong ANA, it goes well in favor of Lupus. All these symptoms fit in very well with lupus. Rheumatoid Arthritis, we dont expect the other symptoms except joint pains. Even though your Anti CCP is positive (but the titres are only mildly raised), we label it as Rheumatoid only if the joints are characteristically swollen i.e. the small joints of the hands, feet, wrists along with early morning stiffness.

I suppose the ENA profile you have done is negative. It can still be Lupus even if only ANA is positive. That is a good sign if the further antibody tests are negative, which gives us a good prognostic sign that there may not be a major organ involvement. The symptoms you have, we normally label it as a Minor Organ lupus. It is important, as the treatment of lupus depends on the organ involvement. I hope they have checked your urine routine and the remaining tests as well.

My diagnosis would be Lupus here. But considering your anti CCP to be positive, i would like to keep a watch on the joint swelling cause at times Rheumatoid arthritis and Lupus can overlap as well. Lupus we dont expect joints to have structural damage, they may be just swollen and tender but no damage inside. With Anti CCP, we need to watch for it

Hope the information was useful

Do let me know for more queries. Would be happy to answer it

Regards
Dr Naval
Above answer was peer-reviewed by : Dr. Vaishalee Punj
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Answered by
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Dr. Naval Mendiratta

Rheumatologist

Practicing since :2007

Answered : 754 Questions

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Suggest treatment for aching muscles and increasingly painful joints

Brief Answer: ? Is it lupus Detailed Answer: Good evening Thank you for writing on health care magic Well, considering the symptoms you have of oral ulcers, photosenstivity, Blue toes( ? Raynauds) along with myalgia and arthalgia along with such strong ANA, it goes well in favor of Lupus. All these symptoms fit in very well with lupus. Rheumatoid Arthritis, we dont expect the other symptoms except joint pains. Even though your Anti CCP is positive (but the titres are only mildly raised), we label it as Rheumatoid only if the joints are characteristically swollen i.e. the small joints of the hands, feet, wrists along with early morning stiffness. I suppose the ENA profile you have done is negative. It can still be Lupus even if only ANA is positive. That is a good sign if the further antibody tests are negative, which gives us a good prognostic sign that there may not be a major organ involvement. The symptoms you have, we normally label it as a Minor Organ lupus. It is important, as the treatment of lupus depends on the organ involvement. I hope they have checked your urine routine and the remaining tests as well. My diagnosis would be Lupus here. But considering your anti CCP to be positive, i would like to keep a watch on the joint swelling cause at times Rheumatoid arthritis and Lupus can overlap as well. Lupus we dont expect joints to have structural damage, they may be just swollen and tender but no damage inside. With Anti CCP, we need to watch for it Hope the information was useful Do let me know for more queries. Would be happy to answer it Regards Dr Naval