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Ana negative still rhuematoid arthirits possible

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Hi, I have progressive joint inflammation accompanied by pain and restricted movement. It started 21 December when I injured my elbow doing 6kg alternate dumbbell lifts. Ultrasound showed swollen Alar nerves. This seems to have dies down, but elbow joint clicks, swollen and red. I have R shoulder pain down when lifting which has a buritis. My hands wrists are swollen, my knuckles are red and swollen too and when I clench a fist it stiff and clicks in quickly. Moving my wrist up and down I have a tremor. I shoulders give me a tremor / robotic feeling. My knees are very agony and cannot bend or walk as I did. They seem to 'protrude' out like the knee cap got bigger. Activity aggravated it. My toes click and joints feel swollen as do ankles. Ankle bones appear bigger. XRay of knee saw no effusion or reduced joint space; XRay ok. Remotoligist put me on Plaquenil; third day on it. Dr said I had Rematiod Arthritis. January I was under great stress and took Lexpro and had major reaction of depression so creased this. I'm confused my body is aggressively changing daily - this morning my left hip joint swollen overnight. I'm confused. If this is autoimmune - why is my ANA ok? My is CRP is 'static at >1 so no infection. Three weeks ago had v bad flue. Still sniffle. ESR was raised t0 7 4/2/13 but down to 2 21/3/13. Believe the raise was due to 'egg' white x 28 per week (?) Kidney function ok. Liver ok. If I have RA - why all the negative indicators? What else can I order to test? Please advise. Daily this thing is aggressively attacking me. I'll also upload a Word Doc. Please see. Please help me with diagnosis / making sense of this.

Category: Internal Medicine Specialist

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Category: Internal Medicine Specialist
 31 Doctors Online

Thank you for asking the query.
I am sorry to hear about your health condition and will try my best to help you here.

The question you have raised – why your ANA levels, CRP, LFT, RFT, X-ray etc. are normal if you are having Rheumatoid Arthritis is a valid.

I will explain why. First of all there is no single test which can diagnose Rheumatoid Arthritis. Instead we use very scientific guideline called EULAR criteria to diagnose RA. You can see it here : -

So the diagnosis is based on the points you have based on the points. As you can see CRP is just one among the many factors that can be positive in a RA patient. ANA positivity is not needed at all. Infact ANA and Rheumatoid disease have no direct correlation. So essentially you can have negative ANA and other tests and still be diagnosed as RA.

In other words, the diagnosis of RA is mostly clinical – that is by a judicial clinical examination of the patient by an experienced Doctor. From your description of symptoms it appears that you are having Rheumatoid arthritis. So a thorough evaluation for RA should be done. I am sure your Doctor might have already done that.  If these evaluations are not suggestive of RA then we need to consider other diagnostic possibilities

The tests I specifically recommend are: RA Factor, Anti-Citrullinated Protein Antibody (ACPA).

The fact that your liver and renal functions are good should be taken as a positive sign.

You should make sure that you are seeing a Rheumatologist or a Doctor with expertise in RA management. Proper treatment will ensure symptom relief  and you can lead a normal life.

Hope this helps.In case I have missed any of your concerns, please ask via this email itself as a follow up query.

Thank you

Dr. Steve Merris
Category: Internal Medicine Specialist
Medical School - New York University
Internship in Internal Medicine - Beth Israel Medical Center
Residency in Internal Medicine - Beth Israel Medical Center
Fellowship in Pulmonary and Critical Care Medicine - Columbia University Medical Center
Dr. Steve Merris and 4 other Medical Specialists are ready to help you

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