Dr. Ashaq Hussain Parrey
Rheumatology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
I am a 31-year-old male. I have vitiligo and recurrent iritis in my right eye, it started 12 years ago. It has been only a month since I started running 5 km every day. And also, I have walked and played soccer a lot on the beach for the last few days. One of these days, a sharp pain appeared in both feet (metatarsalgia) while playing soccer barefoot on the beach. It went away when I stopped playing, but every time I tried to run, it comes back. After a week, I started running again, and the third day the pain came back, but it is way worse in the right foot. After that, I stopped running but continued playing soccer once a week. Today, the pain is worrisome only in the right foot, and it hurts a lot more than the subsequent days. However, it hurts a little bit in the left foot also. I went to the primary doctor, and they did X-rays on the right foot. Those reports were analyzed by a radiologist, and there is nothing wrong with the report. I am writing because I am worried that I may have rheumatoid arthritis. I feel this because the onset was symmetric, and I also have iritis and vitiligo, which makes this particular autoimmune disease more likely. Since I started obsessing about this disease, I started feeling some pain in my hands also but not resembling morning stiffness. I wanted to know how likely do you think it is that I have this disease.
Hello,
Welcome to icliniq.com.
The symptoms that you have described do not classically fit rheumatoid arthritis. However, these symptoms suggest trauma more than inflammatory arthritis, but simultaneously considering your iritis we need to rule out enthesitis and rheumatoid arthritis both of which can be progressive unless addressed. I suggest you get a few blood tests done. Anti-CCP (cyclic citrullinated peptide), ESR (erythrocyte sedimentation rate), CRP (C-reactive protein), and HLA B27 (human leukocyte antigen). For the time being, I suggest you to avoid running and use some NSAIDs (non-steroidal anti-inflammatory drugs) after dropping your blood sample for tests. Regards.
Patient's Query
Thank you doctor,
I went to a primary doctor. She made me to do tests for ESR, RF and ANA. I already had a HLA B27 test some time ago that came back negative.
The test results were:
- RF: Negative
- ESR: 3 mm/hr (negative)
- ANA screen: positive
- ANA titer: 1:40
- ANA pattern: Nuclear, Speckled
She also ordered a TSH test, since my mother has Hashimoto Thyroiditis and vitiligo. I have vitiligo, and I had a positive (high) value of TSH one year ago. It came back normal (4.378 uIU/mL). I am still having pain in my feet and hands, but not swelling or stiffness. I wanted to know what conditions do you think I may have according to the results of my tests. I will get referred to a rheumatologist, but it will take some time I think. Thank you.
Hi,
Welcome back to icliniq.com.
First thing, you have post traumatic pain which seems most likely a minimal hairline fracture which you are not allowing to heal as you are constantly putting the foot in strain. It will take about 4 weeks of avoiding football and running. Just go for walk and do upper body workout. ANA titre less than 1: 100 is considered negative. So don't worry about 1: 40 titre. You have autoimmune thyroiditis and vitiligo that is true but no Lupus or rheumatoid arthritis and I can assure you that.
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Rheumatology
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