Brief Answer: Chronic infection or rheumatoid arthritis. Detailed Answer: Hi XXXX, Thanks for writing to XXXXXXX I went through your query and understood your concerns. Follicular hyperplasia in lymph node is basically due to stimulation of B- cell(a cell which fights against foreign material in body). Common cause for follicular changes in lymphnode is repeated infection could be bacterial or viral. Follicular hyperplasia must be distinguished from follicular lymphoma (bcl-2 protein is expressed in neoplastic follicles, but not reactive follicles). As in your case malignancy is ruled out, its a good sign. Not to worry. Increased lymphocytes indicates infection which is not adequately treated for long time resulting in chronic infection, repeated infection can result in enlarged lymph nodes. If a patient comes to me with these symptoms first I would like do completely physical examination to check for source of infection: throat infection, any tooth caries, nasal sinus, ear examination. So first I would like rule out source of infection first order including Tuberculosis, HIV as well. As your lymph node biopsy is negative for malignancy, I would still like to order an excisional biopsy by removing the lymph node completely and sending for HPE by pathologist. Your above mentioned symptoms are common in infection or other immune abnormalities. Rheumatoid arthritis(though RA factor negative) is in picture because of your joint pains. A negative RF does not rule out RA, because of this low specificity. Please take my opinion to your primary physician. Wish you a good health Regards

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Brief Answer: American College of Rheumatology criteria. Detailed Answer: Hi, Thanks for follow up query. HPE mean histo pathological examination. Tissue sent will be examined after staining under microscope. Diagnosing rheumatoid arthritis (RA) in the early stages can be difficult. There is no single test that can clearly identify rheumatoid arthritis. Instead, we diagnose rheumatoid arthritis based on factors that are strongly associated with the disease. The American College of Rheumatology uses this list of criteria: 1.Morning stiffness in and around the joints for at least one hour. 2.Swelling or fluid around three or more joints simultaneously. 3.At least one swollen area in the wrist, hand, or finger joints. 4.Arthritis involving the same joint on both sides of the body (symmetric arthritis). 5.Rheumatoid nodules, which are firm lumps in the skin of people with rheumatoid arthritis. These nodules are usually in pressure points of the body, most commonly the elbows. 6.Abnormal amounts of rheumatoid factor in the blood. 7.X-ray changes in the hands and wrists typical of rheumatoid arthritis, with destruction of bone around the involved joints. However, these changes are typical of later-stage disease. Rheumatoid arthritis is officially diagnosed if four or more of these seven factors are present. The first four factors must have been present for at least six weeks. More recently, guidelines have changed somewhat in an attempt to diagnose RA in its earlier stages. You should also evaluated to rule out infection like tuberculosis and retrovirus. Hope this information helpful to you. Feel free to ask further related query. I will be glad to answer them. If satisfied close the query and rate it. Regards

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