What Causes Swelling Of Fingers,wrists And Toes?

Brief Answer:
Meticulous Examination and Management

Detailed Answer:
Dear XXXX

Thanks for contacting Ayurveda with your health concern and since she is under treatment and Pediatric guidance, thus your attending doctor is taking full consideration of the case [be under his/her regular guidance], and following points are worth mentioning prior to initiate Management Aspect, since owing to her age, I will not prescribe any medicine [without prior physical examination or evaluation]

1. CRP [C-reactive protein] is a plasma protein which is often used to distinguish infection [high] from disease activity [not high] which increases in response to:
. Infection
. Inflammation
. Tissue Necrosis
. Trauma

i. Since Rheumatoid factor [RF] is normal thus can be excluded as cause of inflammation, even then at her age ask for ASLO [anti strepto lysin titre test] with X-ray chest and EKG. [for endocarditis]
ii. since anti nuclear antibody [ANA] test is negative even then ask your doctor to exclude possibilities of SLE, drug induced lupus, mixed connective tissue disease, bacterial endocarditis, lung disease.
iii. since stomach remains bloated, check for inflammatory bowel disease [IBD]
iv. since monocytes are increased thus again check for infection [hidden], including any immune cause.
PS. make sure there isn't any running viral infection around your locality [measles/ mumps]
v. I'm not been able to view ESR test in your reports, either it has not been done or have been missed, check with concerned authority. [ESR will not diagnose but will reflect ongoing disease activity]
vi. Since blood picture shows iron deficiency anemia:
low hemoglobin, low MCV, low hematocrit but because white blood cells [WBC] is normal and hematocrit is low thus blood disorder is excluded [unless proved otherwise]

2. Since corneal dystrophy is the assessment of Pediatric Ophthalmology Doctor, thus remain under his constant surveillance and guidance [since age of child is less and also test was conducted in Nov' 2013, so what was the review of Doctor ]

3. since gestation age was 36.5, [A normal pregnancy range from 38 to 42 weeks] so if it was an early labour [premature] thus one reason for CPAP and IV antibotics and possible cause of Pneumonia [viral illness]
PS. is her Immunization complete till date? [has she been given pneumococcal vaccine]

4. Since GFR is low: although GFR is the best indicator of renal function in children and is critical for diagnosing acute and chronic kidney impairment but cannot be accurately measured in children who are not toilet trained, thus use of iohexol plasma disappearance serves as a promising alternative to inulin for precise, accurate, and relatively rapid determination of GFR. [for establishing any kidney disease.

Do revert back for any concerns and clarifications

Dr. Munish Sood
Naimittika

---