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Suggest Treatment For Elevated CRP Levels In A Person With Negative Rheumatoid Factor

Posted on Tue, 9 Jun 2015

Question: Elevated crp of 7.4 rheumatoid factor negative. Hand and foot pain bilateral. All autoimmune test negative. What should I try next?
Hx of kidney stones. Cbc normal, thyroid panel normal. Aso was slightly elevated.

Answered by Dr. Naval Mendiratta (49 minutes later)

Brief Answer:
Cause of joint pains

Detailed Answer:
Good evening

Thank you for writing on health care magic

Well I would like to know a few more details before guiding you further...

1. Duration of the pain?

2. Is there any early morning stiffness or night pains? If yes for how long

3. Have you noticed any swelling in the joints

4. ANy other history of dry eyes/dry mouth/oral ulcers/hair fall

5. Any symptoms of irritability/forgetfulness/decreased sleep?

6. Was The Anti CCP antibody test carried out? What about the vitamin D levels

Well, your CRP is not so high for the inflammatory arthritis. Since Rheumatoid factor and autoimmune test are negative, but you are still experiencing pain we need to look into other causes. Do let me know these queries and I will be able to guide you further

REgards
Dr Naval

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj

Follow up: Dr. Naval Mendiratta (1 hour later)

1. Consecutive pain for 6 months. First noticed pain 4+ years ago
2. Yes morning stiffness is bad. First noticed with first pregnancy 4+ years ago but became worse 6 months ago.
3. No major swelling noticed. Slight swelling in hands.
4. Hair falls out all the time. Did notice mouth sores when pai. First became bad 6 months ago.
5. Irritability yes at times. Forgetful yes. Insomnia at times.
6. Anti ccp not done. Vitamin d not checked.

Answered by Dr. Naval Mendiratta (10 hours later)

Brief Answer:
Arthritis

Detailed Answer:
Good evening

Well, considering your history along with the swelling( in hands) , early morning stiffness I would suggest you get your Anti CCP checked along with ESR and CRP. These are the markers for inflammation and will give us an exact status on your arthritis.

Secondly, It can still be an arthritis even if RF, CCP, ANA all are negative. It is called as the Seronegative variant. Although it has a good prognosis, but it still needs treatment. The diagnosis is based on the clincial examination, but if the doubt remains an Ultrasound of the joints is very specific.

I beleive you can get these tests done along with Vitamin D Levels, to give us an exact clue if it is inflammatory or non inflammatory. The treatment will vary accordingly

Do let me know for more queries. Would be happy to help out.

Regards
Dr Naval

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

Follow up: Dr. Naval Mendiratta (14 hours later)

Esr was with in normal limits. Also I currently have a painful sore in my nose. Even if Ana came back negative could it be lupus? Could it fibromyalgia? My Nurse Practitioner said it could be RA or fibromyalgia but the rf came back neg.
What medicine do you think will work since nothing else has?
The only time I had relief was when I was on Norco for kidney stones. I just don't know what else to do.

Answered by Dr. Naval Mendiratta (11 hours later)

Brief Answer:
Fibromyalgia

Detailed Answer:
Good evening

Yes, it can be Fibromyalgia as well. Moreover Fibromyalgia is a diagnosis of exclusion, that is we have ruled out any cause of Arthritis or Vitamin D Defeciency, then we label it as fibromyalgia.

I would suggest you get your vitamin D Levels checked( I am suspecting it will be low) and Anti CCP done. If Anti ccp is negative, there is a high possibility of Fibromyalgia for which we commonly use Duloxetine or Amitryptilline for which you will need presciption from your doctor.

I Hope the information was useful

Do let me know for more queries

Regards
Dr Naval

Above answer was peer-reviewed by : Dr. Prasad