Thank you for your query at DoctorSpring.com
I am again curious with your history and elevated ESR.
I would have added CRP, ANA by immunoflouroscence method and anti CCP in initial work up. I come across early arthritis the way you have, probably 5 cases a week and adding USG of hand adds to the yield.
If your CRP is also elevated it will help in getting towards diagnostic work up. CRP is not a very costly test. And on the day you feel the worst i would have got your USG of hand and wrist to see any inflammation. and if you were a smoker anti CCP is essential test. If there is history of sun allergy(photo sensitivity) hair loss over and above than usual daily loss, oral ulcer etc ANA is again a requirement.
If you are essentially vegetarian, Vit B12 asssay is a requirement. some time hypovitaminosis of Vit D can cause fatigue and pain all over.
I think you should be vigilant it can be disease in evolution were appropriate test is required at correct time to clinch the diagnosis.
If you can elaborate your symptoms it may also help you.
Patient replied :
To be more specific my symptoms started mainly at night in my shoulders-had difficultly getting comfortable, that is still true. However, some days I have sore joints, stiff muscles and fatigue all day long, other days I feel fine. I also have a pins/needle feeling all over on and off. It has been on and off since the end of January.
I am not a vegetarian, but due to food allergies I do not have a great diet (mostly chicken, spinach, wheat, apple, egg, potato, and soy) so I take a multivitamin. I've had migraine since teenage years.
I do not think I had a CRP test, not familar with it. Do I ask my PCP for this? I'm not sure where to go from here. My aunt has RA and my mom has Hypothyroidism but as of now I am negative.
I would keep a diagnosis of evolving RA or VERA, the problem of documenting clinical synovitis in early RA, which is very difficult, I use CRP and USG of hand with wrist as protocol to pick the cases early where there is a window of opportunity of treating disease very early. I donot hesitate in discussing with my patient the economic impact of full blown disease or established disease versus early disease which is quite often missed even by rheumatologist. i run an early arthritis clinic and I have known the utility of MRI and USG to clinch a diagnosis. The MRI can tell me a lot where the preliminary test would be mute. The site of inflammation can be surrogate of type of arthritis, sometime we have post viral arthralgias which has different MRI picture than Early RA or connective tissue disorder. My aim is to help you in moving forward in case of early RA? Tie up with your rheumatologist and insurance provider as we have different system of heath care in India compared to west. CRP is just 8 $, MRI 200$, ANA 20$ and most of the consultant charge anything between 10$ to 30 $ per visit.
I hope so that you will discuss with your GP/ Rheumatologist.