How to treat RA with high RA factor and swollen joints?

Question

Hello doctor,

I want a good rheumatologist for my wife, who has been diagnosed with rheumatoid arthritis. She has an RA factor 150 and no other problems in blood reports. Anti-CCP is negative. She has swollen fingers in both in her hands and legs. She is currently on Shellcal 500 and D joint capsules.

Answer 1

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 could 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? Are there any other medications for diabetes or thyroid is she taking?

Thank you.

Answer 2

Hello,

Welcome back to icliniq.com.

With your history and reports, one thing I want to be certain of 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 positive rheumatoid factor along with joint pains, swelling, and fatigue. The only thing not favoring rheumatoid arthritis is the normal CRP (C-reactive protein) despite so much inflammation. Anti-CCP can be negative in a 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 workup.

As for medications, the safest bet we can start with is tablet Hydroxychloroquine 200 mg twice daily. To start stronger medications for RA, we will plan after this test.