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Joint Pain In Feet, Hands, Knuckles, Thumbs, Mouth Sores, Dry Mouth, RA Test Result Negative, Anti-ccp3 IgG Positive, Sicca Normal. Causes ?

Posted on Thu, 7 Jun 2012

Question: I have had all negative test results for RA EXCEPT positive anti-ccp3 IgG. My joint pain is level 4 out of 5 on my feet, hands (mostly large knuckles and thumbs). I have had mouth sores for 6 months (dry mouth also). All test for Sicca are also normal.

Answered by Dr. Praveen Jadhav (5 hours later)

Hello.

Thanks for posting your query.

As you have mentioned any questions directly, I presume, you want to know whether this is Rheumatoid Arthritis?

I need to know some more things to suggest you better.

1. What is the duration of pain?
2. Is there stiffness in joints when you get out of bed in morning?
3. Is there family history of arthritis?
4. Is there hair loss?

Diagnosis of Rheumatoid Arthritis is mostly clinical with minor importance to investigations. Positive anti CCP (anti-cyclic citrullinated peptide antibody) means, that in all likelihood you have rheumatoid arhtritis. But, this test needs clinical correlation also.

I suggest you to consult Rheumatologist for the opinion on this, as he can simultaneously examine you.

However, sores do not fit in presentation of RA, though dryness (in spite of normal sicca tests) is very common. For sores, please rule out allergy to any of your current medications. Lupus is unlikely at this age, but can give rise to sores plus joint pains. So check for XXXXXXX as well.

I hope, I have answered your query.

I will be available for follow up queries if any.

Regards.

Above answer was peer-reviewed by : Dr. Jyoti Patil

Follow up: Dr. Praveen Jadhav (9 hours later)

--Pain is constant and stiffness when I wake up or have been sitting for awhile
--My mother and grandmother have arthritis
--Not sure about hair loss

--My Rheum thinks that I am not in an active state. Pain 100% of the time is ACTIVE to me...regardless of what my test results (sed rate, crp etc...). I was given steroids yesterday (5 mg TID) and feel so much better today. So my question....can you be in an active state without clinical numbers being out of range. Numbers are only part of the pie.....patient observations are just as important. Because I am much better today after 4 doses of Prednisone does that prove that I am in an active state of RA?

Answered by Dr. Praveen Jadhav (9 hours later)

Hello again,

Rheumatoid activity is judged by 2 things -

Firstly, clinically, if you have pain, early morning stiffness and swelling, your disease is active.
Secondly, high ESR and CRP indicates active disease. However, there could be other associated reasons for these high parameters. Infections are common cause of increasing sedimentation rate and CRP.

However, from what you describe, it does appear that your disease is active. Additional information provided by you, does make your diagnosis of Rheumatoid arthritis stronger.

Though steroids are fine at this stage, you may want to ask your doctor about starting DMARDs, the ideal medications for Rheumatoid arthritis.

Hope I have answered your query.

Regards,

Note: For further queries, consult a joint and bone specialist, an Orthopaedic surgeon. Book a Call now.

Above answer was peer-reviewed by : Dr. Shanthi.E