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ZookGirl
10-19-2013, 06:40 AM
Hello...
I had sudden onset of severe symptoms on 9/29/13. It started with waking up in the middle of the night and not being able to straighten my left leg out. Xrays and MRI of the hip and knee were normal. I was given a Medrol dose pack and within 24 hours I could tell a drastic improvement. I finished the pack on 10/9, had labs drawn on 10/16. I do not have an appt with my PCP until Thursday and an appt with Rheumy 11/1. I was able to obtain the lab results and I am confused by the findings. Any advice, or indications as to what lies ahead would be greatly appreciated!!

Sed rate 6
C reactive protein < 0.10
RF 7
CCP < 16
ANA Negative

The interpretation at the end of the lab results reads, "These seriologic results may be found in 10-20% of patients with polyarthritis that is clinically and radiologically indistinguishable from RA."

What does this all mean and what is polyarthritis?

vegator
10-19-2013, 07:38 AM
I donīt know that much about RA but polyarthritis means inflammation of multiple joints which is the hallmark symptom of RA. The lab comments basically means even when these tests are negative for RA (as they seem to be in your case), some people still have disease (polyarthritis) that is consistent with RA.

I donīt know what symptoms you currently have but such a sudden onset in one area seems a bit unusual for RA. Do you have joint pain and inflammation that are typical of arthritis? Since the MRI was normal one could wonder whether other causes (such as a neurological cause which could be in different part of the body) has been ruled out. The fact that the steroids helped could point to arthritis but doesnīt rule out other causes. But it depends on your symptoms.

ladybud
10-19-2013, 07:52 AM
Welcome to the boards! Sorry you had such a sudden, scary presentation like this! At this point, your inflammatory markers and tests for Rheumatoid arthritis and lupus are negative, but obviously you had an acute inflammatory process in your knee/hip that responded well to Prednisone. Early in rheumatoid conditions, blood tests are often negative. I would try to get a copy of your xray and MRI reports, as there may be some clues in those. Many times, patients are told results are normal, when there is something that shows up that is not. (like an erosion, characteristic of RA). Polyarthritis just means arthritis in more than one joint. The labs often include a statement about interpretation of blood tests, and are general statements, not specific to your case. So it doesn't mean you have polyarthritis, only that 10-20% of people with polyarthritis can have negative blood tests. If you had NO trauma to these joints, including excessive walking or overuse, this could be the beginning of an inflammatory condition like RA or lupus, OR it could be a one time occurence that will not repeat itself. Unfortunately, only time will tell. Bottom line is, consider your family history for autoimmune diseases, especially arthritis related ones, repeat these tests if you have any future episodes similar to it, and use this as an opportunity to learn more about lupus, RA, and similar autoimmune conditions. If you never need the info for yourself, it will enhance your knowledge related to your nursing career, so time not wasted. You might also ask PCP to check CBC, chemistry panel, urine for other clues that may exist related to this episode of joint pain. It will serve as a baseline for comparison and possibly pick up clues that may be missed if these tests aren't done. Good luck and glad the Prednisone helped you feel better fast.

ZookGirl
10-19-2013, 07:55 AM
I have had plantar fasciitis in both of my feet for about 5 years, I have read in different places that sometimes that is where RA starts?? Since the onset of the issues with my left knee, I have experienced pain in my right although not nearly as severe. I have also develop a purple almost bruised looking rash on top of both of my thighs as well as a geographic tongue. The pain in my knees and feet are constant.

vegator
10-19-2013, 02:04 PM
I have had plantar fasciitis in both of my feet for about 5 years, I have read in different places that sometimes that is where RA starts?? Since the onset of the issues with my left knee, I have experienced pain in my right although not nearly as severe. I have also develop a purple almost bruised looking rash on top of both of my thighs as well as a geographic tongue. The pain in my knees and feet are constant.

The rash/bruising can be an important clue to the diagnosis. Has your doctor seen it?

Spontaneous bruising can be a clotting issue. You should discuss that with your doctor. I donīt know whether a blood clot can present with knee pain but I would ask you doctor about it to be sure. Do you have any swelling/redness in your leg? Maybe someone else can chime in.

There are also rashes that are seen in RA or Lupus and there is a clotting issue (antiphospolipid syndrome) that can be associated with Lupus.

ZookGirl
10-19-2013, 02:13 PM
Yes, my PCP and Ortho saw the rash, both said they thought all of the symptoms were autoimmune related. They both ruled out any sort of clot, all of my labs CBC and Chem 7 were pristine. I'm stumped!!

vegator
10-19-2013, 02:52 PM
I donīt think the CBC can be used to rule out blood clotting issues -- it can detect an abnormal level of thrombocytes but that is only one of many possible causes of clotting issues. There are more specific tests and anti-phospholipid syndrome can also be tested for. This seems worth investigating especially with the bruise-like rash. If thereīs actually a clotting issue I think you wouldnīt want to wait until the Rheumatologist appointment to find out about it (if it is anti-phospholipid syndrome it is both a clotting issue and auto-immune related).

ladybud
10-19-2013, 04:41 PM
The rash may be a symptom of an autoimmune disorder. If it looks like pinhead size purple dots (petechiae) it may be related to low platelets or platelet dysfunction. A mottled, lacy weblike-like purplish rash is livedo reticularis, common in lupus and AI disorders with vasculitis. Many AI patients get actual bruises more easily. I would look up the 2 rashes I mentioned and see if either looks like what you have. As far as blood tests, up to 40% of RA patients have negative blood tests for RA factor. Anti-CCP is more sensitive and shows up earlier in the course of disease, so I would request that test be repeated in future for RA. If your MRI shows erosions in joint, that is pathognomic of RA. Geographic tongue also occurs in autoimmune disorders, so you do have several symptoms that could fit. Pinning down exactly which one is difficult and takes time. I would also request in your next blood work an RNP antibody, which is elevated in mixed connective tissue disease.

ZookGirl
10-20-2013, 03:26 AM
Ok, I just finished looking at pics of both...wish I could figure out a way to attach a pic here...but it definitely looks more like livedo reticularis. Thanks so much to all of you who have replied!!!! I am very appreciative!!!!

ladybud
10-20-2013, 09:03 AM
Livedo reticularis tends to come and go, aggravated by cold. Mine always shows up most when I get out of shower. Petechiae stay until they get absorbed, often taking a couple of weeks or more, so the behavior of rash is an important clue. Neither usually itch or cause pain.

ZookGirl
10-20-2013, 09:09 AM
Mine did not hurt or itch and lasted 4-5 days...

ladybud
10-20-2013, 11:57 AM
If you got pictures of it, that's great to show your Dr. when you see him/her. If you didn't, it may return and I would take pics then to store on your phone or computer for documentation.

ZookGirl
10-20-2013, 12:51 PM
I do have the pics on my phone and I have been keeping a pain diary. Hope all of it will be helpful in making a diagnosis!!