My wife has rheumatoid arthritis with high ESR, RA factor and swollen fingers. Please suggest a solution.

Hi,

Welcome to icliniq.com.

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 that the patient will need. So she should be examined properly before commencing the drugs for it. Does she have early morning stiffness? Are there any dry eyes, dry mouth, or oral ulcers? Does any hair fall? Any other medications for diabetes or thyroid is she taking?

Thank you.

Hello,

Welcome back to icliniq.com.

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.