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

Answered by
Dr. Naval Mendiratta
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on Jun 02, 2020

Hello doctor,

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.

Dr. Naval Mendiratta



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 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?

Was this answer helpful?


Thank you doctor,

Morning stiffness and dry mouth are there. No oral ulcer, no hair fall, no diabetes, no thyroid and no medication.

Dr. Naval Mendiratta



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.

The Probable causes:

? Sjogren's syndrome.

Investigations to be done:

ANA (anti-nuclear antibody) ENA qualitative.

Was this answer helpful?


Ask a QueryAsk a Query Consult by PhoneConsult by Phone Video ChatVideo Chat
Also Read Answers From:

Comprehensive Medical Second Opinion.Submit your Case

Related Questions & Answers

Can arthritis be the reason for ankle and wrist pain?

Query: Hi doctor, I get pain in my joints like ankle and wrist occasionally. It goes off when I take Mobizox but comes after a few days again. Also, it goes off when I do massage or when I use compression glove. My uric acid is 10 mg/dL, and it is in a higher range. Does this pain occur due to increased u...  Read Full »

What is the frequency of consultation in the treatment for rheumatoid arthritis?

Query: Hello doctor, I have rheumatoid arthritis. There is a long waiting list to see a rheumatologist in my place. I am thinking of seeing a private doctor but I have limited funds. How often would I need to see a rheumatologist? I cannot afford it every week or maybe every few months. How often do you t...  Read Full »



Ask your health query to a doctor online?

Ask a Rheumatologist Now

* guaranteed answer within 4 hours.
Enter Your Health Query
You can upload files and images in the next step.



Disclaimer: All health Q&As published on this website is not intended to be a substitute for professional medical diagnosis, advice or treatment by a trained physician. Seek the advice from your physician or other qualified health-care providers with questions you may have regarding your symptoms and medical condition for a complete medical diagnosis. Do not delay or disregard seeking professional medical advice because of something you have read on this website.