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Suggest Remedy For Pain And Swelling In Joints When E.S.R Count Is 70 Mm/hr
Question: Hi. I went to the ER on day 7 of pain and swelling that came on in both wrists, both elbows, both knees, and both ankles. Pain started in all 8 joints then daily worsened. On day 4 swelling and heat starting in all 8 joints and increased in severity each day. ER doctor did examination and blood work. ESR rate was 70 mm/hr and my CRP rate is 5.2 mg/dL. I am a 46 year old woman. This came out of no where. I am being referred to a Rheumatologist but appointment isn't until December 10th. Any advice you can give me would be greatly appreciated!
XXXXXXX
XXXXXXX
Brief Answer:
Rheumatoid ARthritis
Detailed Answer:
Good evening XXXXXXX
Thank you for writing on health care magic
Well, the sort of joint pains and swelling you are describing does fit in rheumatoid arthritis considering the symmetrical swelling, pain you are experiencing along with high inflammatory markers( ESR and CRP).
Since it started 7-8 days back, you are still at an early phase and attacking the disease early will definitely reverse the current pain and swelling you are having. We do have a margin period of 4-6 weeks to hit the disease early before it causes any further damage.
But just to confirm which sort of arthritis we are dealing with and how long of a treatment you need, I would like to know a few more queries:
1. Do you experience stiffness in the early mornings?
2. Is the pain worse when you wake up?
3. Any history of dry eyes/dry mouth/oral ulcers/excessive hair fall/rashes over the body?
4. Did they check for your rheumatoid factor and Anti CCP antibody?
Do let me know these queries. Would be happy to guide you further on the treatment part as well
Do continue Naprosyn till then
Await your reply
REgards
Dr Naval
Rheumatoid ARthritis
Detailed Answer:
Good evening XXXXXXX
Thank you for writing on health care magic
Well, the sort of joint pains and swelling you are describing does fit in rheumatoid arthritis considering the symmetrical swelling, pain you are experiencing along with high inflammatory markers( ESR and CRP).
Since it started 7-8 days back, you are still at an early phase and attacking the disease early will definitely reverse the current pain and swelling you are having. We do have a margin period of 4-6 weeks to hit the disease early before it causes any further damage.
But just to confirm which sort of arthritis we are dealing with and how long of a treatment you need, I would like to know a few more queries:
1. Do you experience stiffness in the early mornings?
2. Is the pain worse when you wake up?
3. Any history of dry eyes/dry mouth/oral ulcers/excessive hair fall/rashes over the body?
4. Did they check for your rheumatoid factor and Anti CCP antibody?
Do let me know these queries. Would be happy to guide you further on the treatment part as well
Do continue Naprosyn till then
Await your reply
REgards
Dr Naval
Above answer was peer-reviewed by :
Dr. Raju A.T
1. Do you experience stiffness in the early mornings?
I do, I sometimes sit up on the bed and do some stretching before starting my day.
2. Is the pain worse when you wake up?
The pain in the last 8 days is way worse in the morning, what I would call a hard boil. Then as the day goes on, it goes to medium boil and then by bed is a simmer only to wake in the morning scared to stand up to use the restroom.
3. Any history of dry eyes/dry mouth/oral ulcers/excessive hair fall/rashes over the body?
I have had dry eyes to the point that I have had to have eye drain plugs inserted to keep my tears in my eye long enough to do their job. I don't have problems producing tears, just keeping the moisture in my eye long enough to matter. Note, I did have lasik surgery in 2004.
4. Did they check for your rheumatoid factor and Anti CCP antibody?
I don't see it on my lab work. I thought it might be helpful to let you know my Glucose Level was 96 mg/dL and Creatinine was 0.88 mg/dL.
Hope this helps.
XXXXXXX
I do, I sometimes sit up on the bed and do some stretching before starting my day.
2. Is the pain worse when you wake up?
The pain in the last 8 days is way worse in the morning, what I would call a hard boil. Then as the day goes on, it goes to medium boil and then by bed is a simmer only to wake in the morning scared to stand up to use the restroom.
3. Any history of dry eyes/dry mouth/oral ulcers/excessive hair fall/rashes over the body?
I have had dry eyes to the point that I have had to have eye drain plugs inserted to keep my tears in my eye long enough to do their job. I don't have problems producing tears, just keeping the moisture in my eye long enough to matter. Note, I did have lasik surgery in 2004.
4. Did they check for your rheumatoid factor and Anti CCP antibody?
I don't see it on my lab work. I thought it might be helpful to let you know my Glucose Level was 96 mg/dL and Creatinine was 0.88 mg/dL.
Hope this helps.
XXXXXXX
Brief Answer:
? Rheumatoid Arthritis
Detailed Answer:
Good evening
Thanks for your reply
Probably your symptoms do point towards inflammatory arthritis , probably Rheumatoid.
But to confirm, I would suggest you get Rheumatoid FActor, Anti CCP antibody done. I am not sure if you are allowed to get it, but if you have these tests done before you meet the rheumatologist, it will help him sort your treatment out quickly.
Naprosyn 500 mg is a good drug or you can even try Celecoxib (either of the two) to supress the inflammation till you start on DMARDS/Steroids. But dont worry, you are still in an early phase and the disease can quickly go into remission if treated adequately
Hope the information was useful
Do let me know for more queries.Would be happy to help out
Regards
Dr Naval
? Rheumatoid Arthritis
Detailed Answer:
Good evening
Thanks for your reply
Probably your symptoms do point towards inflammatory arthritis , probably Rheumatoid.
But to confirm, I would suggest you get Rheumatoid FActor, Anti CCP antibody done. I am not sure if you are allowed to get it, but if you have these tests done before you meet the rheumatologist, it will help him sort your treatment out quickly.
Naprosyn 500 mg is a good drug or you can even try Celecoxib (either of the two) to supress the inflammation till you start on DMARDS/Steroids. But dont worry, you are still in an early phase and the disease can quickly go into remission if treated adequately
Hope the information was useful
Do let me know for more queries.Would be happy to help out
Regards
Dr Naval
Above answer was peer-reviewed by :
Dr. Prasad
I sent an email to my GP with the details about my situation. She has access to my lab test results to look at. I sent a picture of my wrist and ankle as a reference and asked if she would be willing to request the tests you suggested to possibly speed up the time to diagnosis and then treatment. This isn't fun. Its scary. Thank you for your feedback and guidance.
XXXXXXX
This is the response I got from my doctor. Do you agree?
From: Reust MD, Carin E
To: XXXXXXX XXXXXXX G
Sent: 12/02/15 10:46:07
Subject: RE: Possible Auto Immune Disease
I understand how you want to move things along, I have placed some orders for lab work as below.
I would not do RF AND Anti CCP as first screen - will start with RF and some others.
Pictures look pretty impressive and hurtful, hang in there
** Submitted: **
Order:Erythrocyte Sedimentation Rate (ESR - Lab Collect)
Details: Blood, Collect Routine, Requested 12/02/2015, Lab Collect, Order for Future Visit, 92.4 kg, Orig Ref Doc Referred, Self
Signed by Reust MD, Carin E 12/02/15 10:44:00
** Submitted: **
Order:FANA with Interpretation (FANA with Interpretation - Lab Collect)
Details: Blood, Collect Routine, Requested 12/02/2015, Lab Collect, Order for Future Visit, 92.4 kg, Orig Ref Doc Referred, Self
Signed by Reust MD, Carin E 12/02/15 10:44:00
** Submitted: **
Order:Parvovirus B19 Antibody IgG and IgM-Mayo (Parvovirus B19 Antibody IgG and IgM-Mayo - Lab Collect)
Details: Serum, Collect Routine, Requested 12/02/2015, Lab Collect, Order for Future Visit, 92.4 kg, Orig Ref Doc Referred, Self
Signed by Reust MD, Carin E 12/02/15 10:44:00
** Submitted: **
Order:Uric Acid
Details: Routine collect, Blood, Start date 12/02/2015, Arthralgia, Order for Future Visit (Post Discharge)?, First Available, Orig Ref Doc Referred, Self
Signed by Reust MD, Carin E 12/02/15 10:44:00
** Submitted: **
Order:Rheumatoid Factor Quantitative
Details: Routine collect, Serum, Start date 12/02/2015, Arthralgia, Order for Future Visit (Post Discharge)?, First Available, Orig Ref Doc Referred, Self
Signed by Reust MD, Carin E 12/02/15 10:44:00
XXXXXXX
This is the response I got from my doctor. Do you agree?
From: Reust MD, Carin E
To: XXXXXXX XXXXXXX G
Sent: 12/02/15 10:46:07
Subject: RE: Possible Auto Immune Disease
I understand how you want to move things along, I have placed some orders for lab work as below.
I would not do RF AND Anti CCP as first screen - will start with RF and some others.
Pictures look pretty impressive and hurtful, hang in there
** Submitted: **
Order:Erythrocyte Sedimentation Rate (ESR - Lab Collect)
Details: Blood, Collect Routine, Requested 12/02/2015, Lab Collect, Order for Future Visit, 92.4 kg, Orig Ref Doc Referred, Self
Signed by Reust MD, Carin E 12/02/15 10:44:00
** Submitted: **
Order:FANA with Interpretation (FANA with Interpretation - Lab Collect)
Details: Blood, Collect Routine, Requested 12/02/2015, Lab Collect, Order for Future Visit, 92.4 kg, Orig Ref Doc Referred, Self
Signed by Reust MD, Carin E 12/02/15 10:44:00
** Submitted: **
Order:Parvovirus B19 Antibody IgG and IgM-Mayo (Parvovirus B19 Antibody IgG and IgM-Mayo - Lab Collect)
Details: Serum, Collect Routine, Requested 12/02/2015, Lab Collect, Order for Future Visit, 92.4 kg, Orig Ref Doc Referred, Self
Signed by Reust MD, Carin E 12/02/15 10:44:00
** Submitted: **
Order:Uric Acid
Details: Routine collect, Blood, Start date 12/02/2015, Arthralgia, Order for Future Visit (Post Discharge)?, First Available, Orig Ref Doc Referred, Self
Signed by Reust MD, Carin E 12/02/15 10:44:00
** Submitted: **
Order:Rheumatoid Factor Quantitative
Details: Routine collect, Serum, Start date 12/02/2015, Arthralgia, Order for Future Visit (Post Discharge)?, First Available, Orig Ref Doc Referred, Self
Signed by Reust MD, Carin E 12/02/15 10:44:00
Brief Answer:
Further Course
Detailed Answer:
Good evening
Sorry for the late reply...Had a long duty
Well I have gone through the mail you have sent me. I dont understand why they are reluctant to carry out anti CCP if the suspicion is so strong . But never the less, they have carried out Rheumatoid fActor and ANA , so it will give us a good screening test to where we are heading.
I am not sure why was parvovirus performed, as we dont expect swelling in viral arthritis, plus it is a self limiting disease
SO when will the results be out...? ESR is already there. The other ones do let me know when they come out.
Await your reply
Regards
Dr Naval
Further Course
Detailed Answer:
Good evening
Sorry for the late reply...Had a long duty
Well I have gone through the mail you have sent me. I dont understand why they are reluctant to carry out anti CCP if the suspicion is so strong . But never the less, they have carried out Rheumatoid fActor and ANA , so it will give us a good screening test to where we are heading.
I am not sure why was parvovirus performed, as we dont expect swelling in viral arthritis, plus it is a self limiting disease
SO when will the results be out...? ESR is already there. The other ones do let me know when they come out.
Await your reply
Regards
Dr Naval
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Another result is in. Can you tell me what this means for me?
RF
< 15 units/mL Date:Dec 02, 2015 01:52 p.m. CST
Reference Range:<= 30 units/mL
RF
< 15 units/mL Date:Dec 02, 2015 01:52 p.m. CST
Reference Range:<= 30 units/mL
Brief Answer:
Rheumatoid FActor
Detailed Answer:
Good evening
Well, it means the rheumatoid factor is negative. It is a good sign. Although arthritis can be present in negative rheumatoid factor also, but the disease intensity is not so severe and it is less damaging. However we still need the Anti CCP value and FANA test to confirm the type of arthritis you are having
Do let me know for more queries
Regards
Dr Naval
Rheumatoid FActor
Detailed Answer:
Good evening
Well, it means the rheumatoid factor is negative. It is a good sign. Although arthritis can be present in negative rheumatoid factor also, but the disease intensity is not so severe and it is less damaging. However we still need the Anti CCP value and FANA test to confirm the type of arthritis you are having
Do let me know for more queries
Regards
Dr Naval
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hi. Latest email from my GP. Your thoughts? Also attaching a photo of my left eye on Nov 9th when I woke up with my eye matted shut and looking like I had pink eye. I had been staying with my mom because she had recently had neck surgery so hadn't been around anyone to catch pink eye. I had antibiotic eye drops and used them but it took about 6 days for it to resolve. Didn't know if this has any impact on this inflammatory issue.
From: Reust MD, Carin E
To: XXXXXXX XXXXXXX G
Sent: 12/04/15 07:25:47
Subject: General Message
so parvo testing negative.
your FANA titer is positive, which may not be truly positive.
I have a sense you are going to read up on FANAs, and that's fine, but I'd suggest you wait to talk with rheumatology first.
FANA are very tricky to interpret.
cr
Results:
12/02/2015 13:52
Parvo B19 IgG-Mayo 3.40 Index ((H)) (<0.90 - )
12/02/2015 13:52
Parvo B19 IgM-Mayo 0.09 Index (<0.90 - )
12/02/2015 13:52
Parvo B19 Intrp-Mayo See Comment
12/02/2015 13:52
FANA Positive ((A)) (Negative - )
12/02/2015 13:52
FANA Titer 1:1280
12/02/2015 13:52
FANA Pattern Speckled
From: Reust MD, Carin E
To: XXXXXXX XXXXXXX G
Sent: 12/04/15 07:25:47
Subject: General Message
so parvo testing negative.
your FANA titer is positive, which may not be truly positive.
I have a sense you are going to read up on FANAs, and that's fine, but I'd suggest you wait to talk with rheumatology first.
FANA are very tricky to interpret.
cr
Results:
12/02/2015 13:52
Parvo B19 IgG-Mayo 3.40 Index ((H)) (<0.90 - )
12/02/2015 13:52
Parvo B19 IgM-Mayo 0.09 Index (<0.90 - )
12/02/2015 13:52
Parvo B19 Intrp-Mayo See Comment
12/02/2015 13:52
FANA Positive ((A)) (Negative - )
12/02/2015 13:52
FANA Titer 1:1280
12/02/2015 13:52
FANA Pattern Speckled
Brief Answer:
ANa Pattern
Detailed Answer:
Good evening
Well, Your ANA is very strongly positive. Titre of 1: 1280 is quite high and your eye problem can be related to it as well. Well , your GP is right in saying consult your rheumatologist, but it can explain all the joint pains you are having.
ANa is a marker of autoimmunity, that is your body s defense mechanism gets altered and it starts attacking you itself rather than defending you. With ANA positive, we need to further classify it where the disease could be heading. ANA is a like a big state with 25 small cities in it, called ENA profile. I am not sure if your GP is authorized to advise you for it, but you can consult him and see if he can get it done.
Secondly starting Hydroxychloroquine would be a good option as well till you see the rheumatologist as it is a slow acting drug, relatively safe and can be taken without much side effects.
Do let me know what they say
Regards
Dr Naval
ANa Pattern
Detailed Answer:
Good evening
Well, Your ANA is very strongly positive. Titre of 1: 1280 is quite high and your eye problem can be related to it as well. Well , your GP is right in saying consult your rheumatologist, but it can explain all the joint pains you are having.
ANa is a marker of autoimmunity, that is your body s defense mechanism gets altered and it starts attacking you itself rather than defending you. With ANA positive, we need to further classify it where the disease could be heading. ANA is a like a big state with 25 small cities in it, called ENA profile. I am not sure if your GP is authorized to advise you for it, but you can consult him and see if he can get it done.
Secondly starting Hydroxychloroquine would be a good option as well till you see the rheumatologist as it is a slow acting drug, relatively safe and can be taken without much side effects.
Do let me know what they say
Regards
Dr Naval
Note: For further information on diet changes to reduce allergy symptoms or to boost your immunity, Ask here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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