Dr. Naval Mendiratta
Rheumatology
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Patient's Query
Hello doctor,
I am a 26-year-old female. I have joint pain widespread bilaterally in my elbows, knees, and ankles. I also have muscle tenderness on my neck and shoulders and back pain from a herniated disc. I take Diclofenac 75 mg PRN for pain. I have had laboratory work done and I have seen a rheumatologist. My initial labs: ANA positive 1:160 speckled. CRP was elevated. My anti-DS DNA, CCP, and RA factor were all negative. Secondary lab work through ELISA showed negative ANA and all other autoimmune laboratories were negative except for positive anti-phosphatidylserine/Prothrombim A at 44 units. Slightly low vitamin D but I take supplements. I eat a plant-based diet and exercise twice a week. My other medical history includes depression and anxiety for which I take medication. My question is despite my labs being negative, why do I still have joint pain and muscle aches?
Hi,
Welcome to icliniq.com.
I would like to ask you a few more queries:
1. Is your sleep pattern fine? Do you have morning fatigue?
2. How frequently are you taking Diclofenac?
3. Do you have hair fall, oral ulcers, dry eyes, or dry mouth?
4. Do you have any recent irritability or forgetfulness?
5. How much was the level of CRP you mentioned?
6. Is there a particular reason for the depression? Is there any family history of endogenous depression?
There can be many reasons for pain. We need to distinguish if it is inflammatory or non-inflammatory. Alone ANA positive may not imply much here. We have to see if it is impacting your system as well.
Patient's Query
Thank you doctor,
1. I do struggle with insomnia and I take Melatonin. Most days I wake up feeling tired and not well rested. Sleep apnea has been ruled out.
2. I take Diclofenac maybe twice a week. Not everyday.
3. None of those. I would say I have watery eyes due to seasonal allergies.
4. No irritability or forgetfulness.
5. The CRP was slightly elevated at 1.74. Oddly enough, my sedimentation rate was normal.
6. Yes, the depression stems from a difficult relationship with my mother from when I was a teen. I do not think there is a family history of endogenous depression.
The best way that I can described feeling is that my body feels like an 80-year-old woman in a 26-year-old body.
Hi,
Welcome back to icliniq.com.
Well, I would like to put forward my conclusions. Although limitation remains with the examination part, will still try to reach the bottom of the diagnosis.
1. ANA can be positive in 5-10 % of the general population, but eventually, we need to see what impact it is throwing. In your case the symptoms you mentioned and further questions I asked did not show that you are heading towards SLE/Sjogrens Syndrome as of yet. Secondly, further test for ANA (ENA profile) is also negative. As for anti-phosphatidylserin is again the marker for APLA syndrome but before advising these tests we need to have a strong pre-test probability. A lot of antibodies can come positive, and if we start chasing them things go haywire.
2. Part of generalized body pain, and decreased sleep depression all head towards a condition called fibromyalgia. Both are very much interconnected and one can lead to the other. You can read about it and see if your symptoms match your current state, as then we can modify the medications a little and try to introduce alternative modes of therapy.
3. CRP we can just observe as well and repeat after 4 weeks to see if it is still high or not. With normal ESR, again the probability of connective tissue disease goes down.
Thank you.
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