Dear XXXXXXX,

The dictum in medicine is that - treat 'patients' rather than treating investigations. Apart from exertional shoulder and back pain (which is quite common), your daughter does not seem to have any physical problem. It is unclear as to why she was prescribed HCQS and steroids. She had joint pains for a while, but as far as diagnosis of rheumatoid arthritis is concerned, it requires additional information regarding the distribution of joint pain, their swelling, duration of pain, and results of blood investigations for arthritis.

High ESR has various reasons. It is a marker of inflammation somewhere in the body. By itself it does not indicate much, but is always read in conjunction with total clinical presentation and other investigations. High ESR could be something as simple as temporary viral infections to as complicated as tuberculosis, arthritis or malignancy. With ESR below 50, serious causes are highly unlikely. In your daughters case, it could be due to infection of joints or due to anemia. Low hemoglobin in turn has hundreds of reasons, but the common ones at 17 years could be menstrual loss, faulty diet, infections, or rarely blood defects.

In summary, if she is asymptomatic, with a mild elevation in ESR, I would not be worried too much. If at all you want to do any further investigations, you can do RA test and Anti CCP test to rule out rheumatoid arthritis and a chest X XXXXXXX (just because she has pain on XXXXXXX breathing) to rule out infections in lungs.

I have not understood 'googles' and it needs more clarification.

Hope your doubts are clarified.

Dr Jadhav

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XXXXXXX,

Of all the results, the most significant result is that of a positive RA test. Since the second test of arthritis - anti CCP - is negative, the diagnosis of rheumatoid arthritis is in doubt, but still a possibility.

So in short, it seems, that you may be worried about the possibility of rheumatoid arthritis. As mentioned earlier, diagnosis is based on symptoms and examination rather than investigations. Many times it is difficult to diagnose RA early in the course of the disease and it takes a few weeks to months to evolve in its classical form. In its classic form, it is diagnosed when there is involvement of both sided multiple joints, associated with morning stiffness and many times with swelling of the joints. Right now since your daughter is mostly asymptomatic, with only exertional pain, symptoms dont seem to be of classical rheumatoid arthritis. It will be wise to wait and keep a watch on the progress of symptoms. It will be wonderful if the symptoms dont progress. In the rare event if they do, only then she may need therapy in form of chloroquine or other treatment. Till that time there is no harm in waiting. At this moment there is no test to predict what will happen in future. RA test can be falsely positive in many cases and is not 100% diagnostic of RA. So, relax for now.

Dr. Jadhav

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