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What Are The Signs And Symptoms Of Rheumatoid Arthritis?
Question: Hello Doctor, besides hypothyroidism (taking 75mcg Thyronorm since 5 years), I also have been seeing high ESR rate in blood tests since 3 or 4 years + feel my joints esp wrist, palm and fingers being stiff & slightly painful. Could there be something beyond hypothyroidism that i am yet to discover & get treated for? What tests should I go for for discovering the issue(s)? Thnx
Brief Answer:
Rheumatoid arthritis to be ruled out
Detailed Answer:
Hello,
Thank you for your query.
I'm Dr. Shuba Hariprasad and will be answering your query today.
Based on your symptoms, I would like to primarily rule out rheumatoid arthritis.
Would you clarify a few things for me?
*what is your height and weight?
*when was the last time you checked your thyroid hormone levels? What were the values?
*do you have any other symptoms like weight loss/gain, fever, myalgia, fatigue, hair loss, irregular menstrual cycles?
*do you have any other medical issues or take any medications?
*is the stiffness of your joints more in the morning and eases as the day goes on? How long does the stiffness last? (approximately)
*do you have it every day? Any swelling or lumps that you notice? Have you taken any pain killers? Does it help?
*do you work? What do you do?
*do you have children?
*have you had any surgeries or any other illness for which you needed hospitalization?
*any one in your family with joint problems or autoimmune issues?
*have you done any other blood tests? How high was your ESR?
I recommend :
-a physician consult and orthopedic opinion
-x-rays of the affected joints
-blood tests (complete blood count, liver function tests including alkaline phosphatase, kidney function tests, C-reactive protein, rheumatoid factor, anti dsDNA, anti-Sm antibody, C-ANCA, P-ANCA)
-urine analysis
Based on these results and clinical findings, a diagnosis can be made.
-avoid sleeping in a cold environment.
-use gloves to keep your wrists and hands warm. See if symptoms improve.
-avoid straining the joints. If you use your fingers a lot, take a break in between for about 5 min every half hour of work.
-exercise-walking is great and helps to improve circulation and ease pain and enable healing.
-minimize stress levels consciusly by deep breathing exercises, proper planning, strict discipline of routine activities, yoga, meditation, listening to your favorite music.
Stress is an important trigger for auto immune diseases.
I urge you to see a doctor regarding this to properly guide you after a detailed medical exam. You may need more tests or may need as many.
A clinical exam can give valuable Insight.
Please get back to me with the above requested clarifications and let me know if there is anything else I can help you with.
Wish you good health.
Regards,
Dr. Shuba Hariprasad
Rheumatoid arthritis to be ruled out
Detailed Answer:
Hello,
Thank you for your query.
I'm Dr. Shuba Hariprasad and will be answering your query today.
Based on your symptoms, I would like to primarily rule out rheumatoid arthritis.
Would you clarify a few things for me?
*what is your height and weight?
*when was the last time you checked your thyroid hormone levels? What were the values?
*do you have any other symptoms like weight loss/gain, fever, myalgia, fatigue, hair loss, irregular menstrual cycles?
*do you have any other medical issues or take any medications?
*is the stiffness of your joints more in the morning and eases as the day goes on? How long does the stiffness last? (approximately)
*do you have it every day? Any swelling or lumps that you notice? Have you taken any pain killers? Does it help?
*do you work? What do you do?
*do you have children?
*have you had any surgeries or any other illness for which you needed hospitalization?
*any one in your family with joint problems or autoimmune issues?
*have you done any other blood tests? How high was your ESR?
I recommend :
-a physician consult and orthopedic opinion
-x-rays of the affected joints
-blood tests (complete blood count, liver function tests including alkaline phosphatase, kidney function tests, C-reactive protein, rheumatoid factor, anti dsDNA, anti-Sm antibody, C-ANCA, P-ANCA)
-urine analysis
Based on these results and clinical findings, a diagnosis can be made.
-avoid sleeping in a cold environment.
-use gloves to keep your wrists and hands warm. See if symptoms improve.
-avoid straining the joints. If you use your fingers a lot, take a break in between for about 5 min every half hour of work.
-exercise-walking is great and helps to improve circulation and ease pain and enable healing.
-minimize stress levels consciusly by deep breathing exercises, proper planning, strict discipline of routine activities, yoga, meditation, listening to your favorite music.
Stress is an important trigger for auto immune diseases.
I urge you to see a doctor regarding this to properly guide you after a detailed medical exam. You may need more tests or may need as many.
A clinical exam can give valuable Insight.
Please get back to me with the above requested clarifications and let me know if there is anything else I can help you with.
Wish you good health.
Regards,
Dr. Shuba Hariprasad
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Please find my answers here. I do take annual preventive medical tests, gave ESR number from last annual test back in July. Pl let me know what specific tests to go for, to discover or eliminate Rheumatoid Arthritis, so i can see an artho depending on the results. tx
*what is your height and weight?
I am 5ft and 63kgs
*when was the last time you checked your thyroid hormone levels? What were the values?
Just about a month ago. TSH was 6.xx
*do you have any other symptoms like weight loss/gain, fever, myalgia, fatigue, hair loss, irregular menstrual cycles?
significant weight gain in last 6 months or so. I used to be 59, gained about 4 kgs in last few months. No fever or general musche ache.
yea, significant hair lost & irreugular menstrual cycles too...had hot flashes too, impacting sleep regime. gynaecologist's impression was it was probably PMS, that needs managed with minimal effects.
*do you have any other medical issues or take any medications? No.
*is the stiffness of your joints more in the morning and eases as the day goes on? How long does the stiffness last? (approximately)
yea, slightly more stiffer in the morning & eases later in the day, but do feel stiffness overall, prompting me to crack the wrist & fingers
*do you have it every day? Any swelling or lumps that you notice? Have you taken any pain killers? Does it help?
so...I dont have a serious problem with it yet, so no medication. meant to check if its related to hypothyroidism or some other thing like that, and address it before it becomes severe.
*do you work? What do you do?
I do, I am a Sr Manager in an IT Company.
*do you have children?
No, I am Single.
*have you had any surgeries or any other illness for which you needed hospitalization?
No
*any one in your family with joint problems or autoimmune issues?
Mommy had knee pain issues a few years ago, is relatively fine now, post medication.
*have you done any other blood tests?
I do take annual medical tests along with my mom, physicians who check medical reports generally ignore high ESR rate as some temp infection elevating it.
How high was your ESR? last test had ESR of 42.
*what is your height and weight?
I am 5ft and 63kgs
*when was the last time you checked your thyroid hormone levels? What were the values?
Just about a month ago. TSH was 6.xx
*do you have any other symptoms like weight loss/gain, fever, myalgia, fatigue, hair loss, irregular menstrual cycles?
significant weight gain in last 6 months or so. I used to be 59, gained about 4 kgs in last few months. No fever or general musche ache.
yea, significant hair lost & irreugular menstrual cycles too...had hot flashes too, impacting sleep regime. gynaecologist's impression was it was probably PMS, that needs managed with minimal effects.
*do you have any other medical issues or take any medications? No.
*is the stiffness of your joints more in the morning and eases as the day goes on? How long does the stiffness last? (approximately)
yea, slightly more stiffer in the morning & eases later in the day, but do feel stiffness overall, prompting me to crack the wrist & fingers
*do you have it every day? Any swelling or lumps that you notice? Have you taken any pain killers? Does it help?
so...I dont have a serious problem with it yet, so no medication. meant to check if its related to hypothyroidism or some other thing like that, and address it before it becomes severe.
*do you work? What do you do?
I do, I am a Sr Manager in an IT Company.
*do you have children?
No, I am Single.
*have you had any surgeries or any other illness for which you needed hospitalization?
No
*any one in your family with joint problems or autoimmune issues?
Mommy had knee pain issues a few years ago, is relatively fine now, post medication.
*have you done any other blood tests?
I do take annual medical tests along with my mom, physicians who check medical reports generally ignore high ESR rate as some temp infection elevating it.
How high was your ESR? last test had ESR of 42.
Brief Answer:
Mentioned below
Detailed Answer:
Hello,
Thank you for the follow up and clarifications.
*your TSH is borderline high. I suggest checking your free T3 and T4 levels and prolactin to manage change in dosage/medications
*blood tests for checking for rheumatoid arthritis (anti-ccp (cyclic citrullinated peptide) antibody, rheumatoid factor, C Reactive protein).
Anti ds DNA, P-ANCA and c- XXXXXXX are other markers for auto immune disorders and is sometimes checked based on clinical findings and suspicion as thes disorders commonly co-exist with rheumatoid arthritis.
*weight gain, irregular periods and even the joint pains can be related to hypothyroidism. The joint pains due to weight gain. Weight gain due to hypothyroidism.
-ideally your thyroid should be in the middle of the normal range (around 3).with symptoms of hair loss, weight gain, irregular cycles and a history of thyroid disorder, this is the most likely cause (inadequate medication dosage).
I don't believe all this fit in under premenstrual syndrome.
I would however suggest an ultrasound to check for ovarian cysts. Checking estrogen, Leutinizing and follicular stimulating hormone levels can also show if there are any primary ovarian insufficiency or pituitary gland disorder.
*the pattern of stiffness and the joints affected point toward a possible rheumatoid arthritis. However, Please note that there is no specific tests that show the presence of this. A clinical approach supported by supporting evidence helps in diagnosis. At times a sound clinical judgement is made even if tests are all normal.
I strongly recommend regulating TSH levels by checking the above mentioned levels and increasing dosage to bring the TSH around 3or below.
Are the rest of your tests normal?.
Hope I've been of help. Please let me know if there is anything else I can help you with.
Regards,
Dr. Shuba Hariprasad
Mentioned below
Detailed Answer:
Hello,
Thank you for the follow up and clarifications.
*your TSH is borderline high. I suggest checking your free T3 and T4 levels and prolactin to manage change in dosage/medications
*blood tests for checking for rheumatoid arthritis (anti-ccp (cyclic citrullinated peptide) antibody, rheumatoid factor, C Reactive protein).
Anti ds DNA, P-ANCA and c- XXXXXXX are other markers for auto immune disorders and is sometimes checked based on clinical findings and suspicion as thes disorders commonly co-exist with rheumatoid arthritis.
*weight gain, irregular periods and even the joint pains can be related to hypothyroidism. The joint pains due to weight gain. Weight gain due to hypothyroidism.
-ideally your thyroid should be in the middle of the normal range (around 3).with symptoms of hair loss, weight gain, irregular cycles and a history of thyroid disorder, this is the most likely cause (inadequate medication dosage).
I don't believe all this fit in under premenstrual syndrome.
I would however suggest an ultrasound to check for ovarian cysts. Checking estrogen, Leutinizing and follicular stimulating hormone levels can also show if there are any primary ovarian insufficiency or pituitary gland disorder.
*the pattern of stiffness and the joints affected point toward a possible rheumatoid arthritis. However, Please note that there is no specific tests that show the presence of this. A clinical approach supported by supporting evidence helps in diagnosis. At times a sound clinical judgement is made even if tests are all normal.
I strongly recommend regulating TSH levels by checking the above mentioned levels and increasing dosage to bring the TSH around 3or below.
Are the rest of your tests normal?.
Hope I've been of help. Please let me know if there is anything else I can help you with.
Regards,
Dr. Shuba Hariprasad
Note: For more detailed guidance, please consult an Internal Medicine Specialist, with your latest reports. Click here..
Above answer was peer-reviewed by :
Dr. Prasad
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