Q. Pain in my hands and wrists. What does my blood work suggest?

Answered by
Dr. Naval Mendiratta
and medically reviewed by iCliniq medical review team.
Published on Mar 16, 2016 and last reviewed on: Nov 02, 2019

Hi doctor,

I am having pain in my hands and wrist and it started a few months ago. It is typically in the morning. I visited a doctor and she did blood tests. The result flagged in my blood tests was anti-Sm/RNP 2.8 and she has referred me to a rheumatologist, who cannot see me for the next two months due to busy schedule. Can you tell me what does it mean?

Dr. Naval Mendiratta

Rheumatology
#

Hi,

Welcome to icliniq.com.

  • Well, the antibody as such does not match your symptoms. It is an antibody for autoimmune disease more like SLE (systemic lupus erythematosus).
  • Since it is positive, I would like to know if your ANA (antinuclear antibody) was positive as well, or only this came positive.
  • Do you have any associated oral ulcers or joint swellings or rashes over the face and body or excessive hair fall?

Revert back with the answers for the above questions to a rheumatologist online --> https://www.icliniq.com/ask-a-doctor-online/rheumatologist

Hi doctor,

I would like to continue this discussion as I cannot get into my doctor for another few weeks and I am worried. The pain I have is in my wrists and hands. There is no numbness or tingling, just shooting pain and stiffness in the morning. The pain comes and goes throughout the day and sometimes in my shoulder joints too. I have attached my entire blood test report for your reference. I looked up SLE symptoms in internet and I do not have any of the skin ulcer, fever, etc. I am curious to hear your thoughts. Thank you.

Dr. Naval Mendiratta

Rheumatology
#

Hi,

Welcome back to icliniq.com.

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 tested 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 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 a 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 a relief.

Investigations to be done:

Musculoskeletal ultrasound of hands.

Regarding follow up:

For further clarification consult a rheumatologist online.---> https://www.icliniq.com/ask-a-doctor-online/rheumatologist

Thank you doctor,

Please tell whom should I approach for the ultrasound. Should I go for it immediately?

Dr. Naval Mendiratta

Rheumatology
#

Hi,

Welcome back to icliniq.com.

  • This ultrasound is usually done by a rheumatologist or a radiologist. You can seek an appointment at ease and no hurry. Meanwhile, try a short course of Cox-2 inhibitor.

For further information consult a rheumatologist online --> https://www.icliniq.com/ask-a-doctor-online/rheumatologist

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