Autoimmune

[jwinter]

Hello there, I am female, 45 fairly fit and healthy. Non smoker, social drinker (white wine) the last 3 months I have been getting pain in my left hand ring finger joint, outer right wrist, outer left knee, not getting any better. No arthritis in my family. I have a rheumatoid factor of 45, my ESR is 9, my CRP was 7.9 (5 weeks ago) but now 4.3, my Anti-CCP test was postive 26.8. My B12 was 416 and rc folate 1545, but i am taking tresos b with selenium  every day.
I have always tested positive to ANA just waiting on my latest ANA test to come back including ENA, anti DS DNA. Vitamin D 75.The only thing that was helping the pain was Voltaren but my doctor said try and stay off that and put me on celecoxib200 mg per day plus paracetemol. Any ideas of what I may have or are there any more tests I should ask for?
Thank you so much Jenny

[jwinter]

Hello there, thank you for replying. I was hoping it wasnt RA but looks like Im stuck with it. As I said I have always tested positive for ANA but my test came back and my reading hasnt changed from 2 years ago. ENA negative and the ds DNA all negative. So at the moment I am on Celebrex 200mg nocte, not really doing much and panadol osteo x 2 bd.
I am going to see a rheumatologist in february (earliest I could get in)
Any other tips or ideas would be most welcome, thank you

[Dr. Kokil Mathur]

Hi!
Since your Anti-CCP test was positive, rheumatoid arthritis is more or less confirmed, and if not managed properly, may cause joint damage. Your other ANA test results will confirm whether you have any other autoimmune disease or not. Though non steroidal anti-inflammatory agents (NSAID) and steroids are the gold standard of treatment, more emphasis should be laid on physical and occupational therapy, rest, heat pads and use of assistive devices for walking. Biological response modifiers like etanercept, leflunomide (used less often), adalimumab, or infliximab can be added in consultation with doctor. These drugs block the actions of immune mediators such as tumor necrosis factor or interleukin-1 involved in the abnormal immune reaction associated with rheumatoid arthritis, thus reducing pain and inflammation. A newer generation of NSAIDS drugs called the COX-2 inhibitors can be tried as they have fewer digestive system effects but these drugs are costly. Osteoporosis should be taken care of by adding calcium and Vit D supplements again in consultation with doctor. Aim of the treatment should be to maintain her in remission stage for as long as possible. Hence a mix and match approach will do better than a simple one on NSAID and steroids. There are many alternative therapies available. Nondrug treatments of RA : physical therapy-  preserves and improves range of motion, gives strength to muscles, and reduces pain; Hydrotherapy- exercising or relaxing in warm water relaxes your muscles and helps relieve pain; Relaxation therapy utilizes various techniques for releasing muscle tension to relieve pain; Heat therapy is achieved by ultrasound, microwaves, warm wax, or warm moist compresses; Cold therapy can be done with ice packs at home; Occupational therapy – modifies ways of using body to reduce stress on your joints.
Vitamin B12 and folic acid supplements should be taken as advised. Take care!