Joint pains, weak positive blood test. No RA says doc.

[lisaanne1]

I am so confused and dont know if I should get a second opinion. My pain started a few months ago in my hip. It would hurt to get out of a chair and start to walk. After taking a few steps I could walk it off and felt fine until the next time I would walk from a sitting position. Then a few weeks later it would start to hurt while sitting and standing. A burning type pain on both sides, but moreso on my right. A few weeks later my left thumb and right ankle started to hurt when i would move them in a certain position or have to use my thumb strength to open lids etc. My ankle would hurt when rotating it and also when turning my foot inwards and when I would first start to walk. Fast forward to another month and I noticed that when I would sit for awhile and then move my right knee, it would really hurt to straighten it out. Again, starting to walk I would have to walk it off in order for it to feel better. Around this time my large knuckle on my right hand would hurt when I would use my hard to bear weight, like getting up off the floor. I have also had discomfort in my right elbow. Occassionaly throught the day my knuckles on my left hand will feel a little sore when I move them. And for the last two days my thumb that has been bothering me when I move it has been hurting with any use. My knee is now worse and feels like it has a kink inside the knee. If I keep it in one position for too long, it does stiffen up until I move it a couple of times to work out the pain.
All of these pains feel as though they are in the tendons of the joints or the tendons around the joints. It is not debilitating pain but the thumb pain is definetely getting worse. For the most part the pain has only been there upon movement. Now its starting to linger for a short while after the movement is over.
I went to my family doc in April and he ran a RA factor and ANA. The RA came back at 12 with the reference range being 0-14. My ANA was negative. He referred me to an orthopaedic. The othro checked my thumb and ankle only, gave me Naproxin and did some more blood work. The results on the blood work were:
ANA - negative
anti ccp - 16 with reference range being less than 20
complete blood count - normal
sed rate - 1 reference range less than 20
c reactive protein - .05 referene range less than 1
RA factor - 17 reference range less than 14

So within a three week period, my RA factor went from 12 to 17. He sent me to a rheumy because of this test and also given the fact that my grandma had RA.

Went to the Rheumy and he look at me and my blood work and said a RA of 17 is a very weak positive and since the previous test was a 12, that it could be machine differences etc. I have no noticable swelling and I am not stiff when in the morning. I just have to talk several steps to get the pain out of my ankle and hip. The range of motion is still there. He said that since all other tests are negative, including anti ccp and sed rate and c reactive protein, I do not have RA. Other than pain, I dont have the usual swelling, red joints and no stiffness for long periods of time.

I hope the doc is right and I have something less sinister than RA. I just dont know what could be causing this kind of joint problems in so many different joints. Should I get another opinion? What are your thoughts on my symptoms?

Thank you!

[carolanivey]

I forgot to add that it is also possible to have positive blood tests one time, negative the next, and so on. So again, don't stick with any doctor who ONLY looks at blood tests. I myself have been in a full-body flare with no trace of it showing in my bloodwork. RA and other autoimmune disorders are slippery little buggers and often refuse to be pinned down. Each patient is like a puzzle that must be solved.

[carolanivey]

It is possible to have something called "sero negative" RA, which basically means your bloodwork is within normal range but you have physical symptoms. A good rheumatologist will know this and treat you based on a broad range of evidence, not just the numbers on your bloodwork.

A "weak" positive is still positive. It is extremely important to note that NO TWO RA PATIENTS ARE ALIKE. They are each unique in symptoms presented, how fast the disease progresses, and which meds work or don't work. You can have little to no visible swelling and still have fast-progressing joint damage, or lots of swelling yet slower progressing joint damage. It is vital that you begin treatment as soon as possible to prevent long-term damage. Definitely seek a second or even a third opinion from another rheumatologist.

I've had RA since age 5 and am now 52, and over the years I have talked with literally thousands of RA patients. Don't give up...even if it isn't RA, you know your own body best and you know something is wrong. Hang in there!

[S. Kaul, MD]

Hi there!

I would agree with your rheumatologist in that this does not look like the clinical picture of RA and since all other tests have been negative, this is unlikely to be RA. Possible causes of joint pain that may need to be considered include infections, reactive arthritis, degenerative arthritis, neuro-muscular issues, micronutrient deficiencies, trauma/ injuries etc. I would suggest seeking a second opinion with another orthopedician for a detailed evaluation and suggestion of an appropriate management plan.
Hope this is helpful.

Take care!