Rheumatoid Disease with a Negative test?

[dcw888]

I'm new here, and wasn't going to post my situation, but I saw a post to this site from over 2 years ago that sounded awful familiar.  Now I'm thinking my situation may not be only mine. I am a 39 year old overweight female on an antidepressant.

In April of 2007 I came down with a terrible illness that I can only describe as the worst sore throat I had ever had, extreme fatigue, achiness everywhere.  It took me out of work for about a week, and blood tests were inconclusive as to whether I had had a re-occurance of mononucleousis (one doc says yes, one PA says no).  A week after returning to work, I was driving home and noticed I had developed pain in my arms when I would steer.  This pain (not unbearable) turned into a tingling sensation in my arms and hands -- mostly my hands and mostly while driving.  I was referred to a rheumatologist, and my c-reactive protein came back elevated, my sed rate came back in the 50s, and my rheumatoid factor came back negative. My symptoms continued and progressed to a combination of tingling and achiness in the joints.  My rheumatologist is convinced I have rheumatoid disease, even though I have a negative result.  He is also convinced that I have recurrant mononucleosis that could occur at any time (something about titers -- that I don't understand:-)).
In discussion with him, I wanted to treat my condition with the occasional ibuprofen and a daily regimen of MSM.  This worked well since my symptoms were only annoying, not painful, and not getting worse.
Fast forward to July 2007.  I have to drive for 2 days to visit my sick father.  Driving is difficult, so my rheumatologist agreed to give me a Medrol pack and he cautioned me it would only give me relief for 2 weeks, then I'd have to take another to get home.  Much to my surprise, that one pack brought relief for 3 months!
Fast forward to January 2008.  I have to drive 2 days to attend my father's funeral.  My rheumatologist agreed to give me a lower dose of Prednisone (at my request -- Medrol was too much).  I chose not to take it.  Things are going fine, my symptoms are all but gone.
Fast forward to June 2008.  I am complaining of acid reflux, especially at night. I've also become lactose intollerant since the stomach bug I had to fight a few weeks prior.  During this time, my dosing schedule of MSM has become almost non-existent (I was getting complacent).  I also have blood in my stool.  A colonoscopy and endoscopy show everything is fine except for reflux with no damage.
Fast forward to October 2008.  My ache in my bones is back, along with joint pain in both arms, hands, legs, feet, and even my toes and fingers.  I have trouble walking to the cafeteria and back without pain (feeling severely out of shape, although I am)  My blood test reveals an elevated c-reactive protein count, sed rate of 45, but still negative for rheumatoid factor (9).  I still have terrible reflux if I don't take my prescription.  I have been taking my MSM faithfully and have started feeling better.  My rheumatologist suggest I'm experiencing a "flare up". And that's where I am today: slight tingling in my fingers, achy joints, pain in my knees, and stiff legs.  I also have terrible mood swings and bouts of depression (my primary physician says it could be autoimmune).

So, sorry about telling my entire life story, but I feel these events are important.  What caught my eye on this site was another woman had mentioned her husband had had a very sore throat, followed by the same symptoms about 3 weeks later and 18 months later she was asking for help.  

Should I press my doctor for an answer other than rheumatoid disease?  Or, should I just let it go until I develop a new symptom that I can't live with?  I know losing weight and exercise will help, but I can't help but think that there is something else going on here.  Does this scenario sound at all familiar to anyone else?

[Bhupinder Kaur, MD]

Hello,

Your symptoms are typical symptoms of rheumatoid arthritis. A negative RF does not rule out RA; rather, the arthritis is called seronegative. This is the case in more than half of the patients. During the first year of illness, rheumatoid factor is frequently negative.Then it is converted to seropositive.

You can confirm your rheumatoid arthritis status by anti-citrullinated protein antibodies (ACPAs).It si very specific test for rheumatoid arthritis.

Another possibility that I can think of is rheumatic fever. Rheumatic fever is an inflammatory disease which may develop two to three weeks after a Group A streptococcal infection (such as strep throat or scarlet fever). It is believed to be caused by antibody cross-reactivity and can involve the heart,different  joints, skin, and brain.Diagnosed by blood tests,ECG heart and throat swab and culture.

Moreover,tingling sensation is a common feature of rheumatoid arthritis but other causes like diabetes,stroke,thyroid disorders,abnormal levels of calcium, potassium, or sodium in your body and a lack of vitamin B12 etc also cannot be ignored.

In my opinion,it will be best to consult a rheumatologist and a physician to9 rule out all the above possibilities.

Hope it helps.Take care and pls do keep me posted on how you are doing or if you have any additional doubts.