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I have gone through your reports (attachment removed to protect patient identity). As of now, all of it is good. The inflammatory markers - ESR (erythrocyte sedimentation rate) and CRP (C-reactive protein) are normal. The rheumatoid factor and anti-CCP (anti-cyclic citrullinated peptide antibody) are negative as well. Anti-Sm/RNP (anti-smith or anti-ribonucleoprotein) is positive, but the ANA test is negative. All these antibodies (ENA - extractable nuclear antigens panel) are a subset of ANA and if ANA is negative, it does not hold much implication. It may be a laboratory error or I would say falsely positive. Secondly, the antibody does not match your symptoms. It is more associated with muscle weakness than joint pains. Your symptoms do go with inflammatory arthritis. Since there is no swelling and laboratory tests are negative, there is not much reason to worry. Examination of the joints is always a superior clue to what exactly is going on than the laboratory reports. We make our diagnosis from clinical examination (90%) and only 10% from the laboratory reports. Having said that, it could still be seronegative arthritis. How to confirm when all the laboratory tests are normal? One way is we can get an ultrasound done for the hands to see if there is any inflammation. If not, it rules it out. Or you can try a short course of COX-2 inhibitors like Celecoxib for five to seven days and see if you get relief.
Investigations to be done:
Musculoskeletal ultrasound of hands.