Question
QUESTION: I recently had a RF test of 191 and a positive ANA.  I will see a rheumatologist, I know many diseases associated with this but I was wondering if one would stand out?  Joint, muscle pain, major fatigue, hair loss, stiffness after sitting no matter what time of day, tingling in fingers, I have Reynauds, thyroid nodules with normal TSH. burning in joints or muscles, but great appetite, almost too hungry!

ANSWER: Hi Lisa,

I need to know what ALL your blood results say, this will tell me what wasn't done as well. Also, I need onset history, imagining studies (if any), medications presently taking ( I feel you may be taking prednisone), and any other info you can give me. (age)(weight)(pertinent family history)

Thanks,

Dr. Timothy Durnin
drs.chiroweb.com
drs.chiroweb.com

---------- FOLLOW-UP ----------

QUESTION: no other blood work or imaging/xray yet.  44 y/o, 67.5", wt. 199 mostly due to inability to exercize, I get off balance and dizzy, even keeping my arm up to blow dry hair is an effort as it just gets so tired. My mom had HTN, Padgets disease, osteoarthritis and Uterine ca caught early, my sister had Sjogrens's disease, dad had HTN, COPD, Sleep apnea. I've been c/o this for at least 5 - 6 yrs with it worsening all the time, pains in wrists, other joints, tingling in fingers. Can't think as clear as usual lately, a little sad because I just feel so "shitty". I just feel like my body can't move anymore. I don't have dry eyes, I think I do get thirsty more but I have been trying to take generic Alieve to help with pain, the dose said 2 to start and then one therafter but only two helps, still get stiff and weak. I do take generic exedrine for migraines on occasion and when I do I do not take Alieve.  I was taking one a day women's vitamins but stopped because that was the only different thing since this started to worsen.  I have had this for years as I said and it always seems to come and go but this time is deffinately the worst.  I just found out that in 2003 my one RF was 60 but ana etc., normal.  I realize you can't really dx but any info that you could give to ask my Dr. would be appreciated. I also can't stand going out in heat lately, Ever since I was a kid I've always liked it darker in a room and eyes feel better, this hasn't changed.  Overhead lights bug me but not a table lamp but as I said It's always been this way.  I just feel like I have waves in my legs and arms.

Answer
Hi Lisa,

You need a more thorough workup by a neurologist. This should include more comprehensive blood work that incudes IgG and IgA antibody tags for food anaphylaxis or allergies. Imaging, MRI of the brain, to R/O M.S. and other autoimmune demylination diseases is warranted, a comprehensive neurological exam that incudes NCV's and any pathological reflexes should be done.
Right now all that can be said is RA is one working diagnosis. With your family Hx, it wouldn't be a big stretch to warrant a specialist, not a rhuematologist, but a board certified Neurologist to work this up. If he/she is stumped, see a top Internal Medicine physician, since anaphylaxis will probably be overlooked by a neuro.
A simple RAST profile would be a good start.
Never the less, the joint pain is a real issue, joint destruction usually follows. To ensure you are doing everything you can to prevent this, take glucosamine sulfate with MSM, this is proven to stop OA and reverse it in many cases. RA was not part of the study, there is plenty of anecdotal evidence that supports it's efficacy, using it has no negative side effects unless you are diabetic, even then it can still be taken. You just need to monitor your BG closely as a person would anyway.
The problem with GS is people don't take the therapeutic dose that was shown to work in the study, they simply don't take enough. It requires 3000mg/day to help effectively. You definitely need follow up with a Neurologist, get a referral or I will write you one.

I would also like to know if your CRP is elevated, this will tell me if an inflammatory process is going on vs. autoimmune, the fact you have elevated RA Latex/factor and ANA, tells half the story. That is you have autoimmune issues, many people have multiple things overlying each other. A CRP will show if there is more directions to pursue diagnostically. Unfortunately, it looks like you will be given a trial of steroids in the form of a Medrol dose pack to start, this is advisable for short term. It may end up being a staple of your meds if you become chronically symptomatic. Let's hope this isn't the case. Please keep me informed.


Good Luck!
Dr. Timothy Durnin
drs.chiroweb.com