I want a good rheumatologist for my wife who has been diagnosed with rheumatoid arthritis. She has got RA factor 150 and no other problem in blood reports. Anti CCP is negative. She has swollen fingers both in hands and legs. She is currently on Shellcal 500 and D jont capsules.
I have gone through the reports (attachment removed to protect patient identity). There is a high ESR (erythrocyte sedimentation rate), RA factor. I would like to take a few more details on the history part. But it would be better if someone can examine the joints as it is a long treatment which patient will need. So she should be examined properly before commencing the drugs for it.
Does she have early morning stiffness? Any dry eyes or dry mouth? Any oral ulcers? Any hair fall? Any other medications for diabetes, or thyroid is she taking?
Thank you doctor,
Morning stiffness and dry mouth are there. No oral ulcer, no hair fall, no diabetes, no thyroid and no medication.
With your history and reports, one thing I want to be certain is that we are not dealing with some other condition which is known as Sjogren's syndrome. Sjogren's syndrome can have high ESR and rheumatoid factor positive along with joint pains, swelling, and fatigue. Only thing not favoring rheumatoid arthritis is the normal CRP (C-reactive protein) despite of so much inflammation. Anti CCP can be negative in few individuals. So I would suggest you get this test done which is pending. ANA (IFA method) and ENA (extractable nuclear antigen) qualitative. That should complete our work up.
As for medications, the safest bet we can start is tablet Hydroxychloroquine 200 mg twice daily. To start stronger medications for RA, we will plan after this test.
The Probable causes:
? Sjogren's syndrome.
Investigations to be done:
ANA (anti-nuclear antibody) ENA qualitative.
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