RA or FM or Lyme?

[Mary]

Willow, like you, I would have thought he would have ordered an RF test too - but on reading about the CCP test, it seems to be more accurate and what is used more. But my sister told me tonight she is going to see a rheumatologist to get it confirmed. Her doctor is a D.O.

I am still puzzled why her joints are not swollen and sore and why she doesn't have the morning stiffness. She does have a lot of pain and a lot of muscle weakness, has trouble moving, recurrent chills and fevers, just not in good shape (although she is still managing to work as a drug and alcohol counselor, but is starting to have to cut back her hours), but her symptoms just doesn't seem typical for RA, from what I read. Hopefully a rheumatologist can shed some light.

I appreciate everyone's feedback and input - thank you!

Mary

 

[Jonathan Edwards]

Willow, like you, I would have thought he would have ordered an RF test too - but on reading about the CCP test, it seems to be more accurate and what is used more. But my sister told me tonight she is going to see a rheumatologist to get it confirmed. Her doctor is a D.O.

I am still puzzled why her joints are not swollen and sore and why she doesn't have the morning stiffness. She does have a lot of pain and a lot of muscle weakness, has trouble moving, recurrent chills and fevers, just not in good shape (although she is still managing to work as a drug and alcohol counselor, but is starting to have to cut back her hours), but her symptoms just doesn't seem typical for RA, from what I read. Hopefully a rheumatologist can shed some light.

I appreciate everyone's feedback and input - thank you!

Mary

Dear Mary,
It sounds as if your sister should see a rheumatologist tomorrow and I suspect they will make the diagnosis in 30 seconds. I cannot be sure, clearly, from what is on this site, but it sounds like a very typical RA presentation. One of the commonest presentations of all is carpal tunnel syndrome with no visible swelling - just tingling in the hands. A proportion of patients get very little swelling and it is as much in tendons as in joints anyway. Morning stiffness is usual but some people do not get it. Muscles are often affected at least with pain. I would hope that every medical student I ever taught would remember that much so I am wondering what has taken this long! Blood tests should be unnecessary if you listen to the symptoms but either RF or CCP positive is pretty home and dry - except that RF is less specific (although more sensitive).

Getting the right treatment for RA can be frustrating because the current policy is still to go through various old fashioned options before trying newer drugs - with some, but not much, good reason. But once the right drug has been found, it is usually possible to keep the person symptom free. In my career as a rheumatologist things went from there being virtually nothing that was any good to the current situation - when I retired I considered it a major exception and disappointment if I had a patient for whom I did not have a treatment that kept them fully well. I wish your sister well. A well informed rheumatologist should be able to get her well.

 

[Mary]

Jonathan - thank you for your response. Her initial symptoms started with pain in her sternum/clavicle area. She had been bumped rather hard in the chest when carrying some boxes, so thought something got out of alignment. And then gradually things got worse and so it seemed likely it might be FM. She has crap insurance so it took awhile to get to a doctor - she's paid for everything out of pocket.

Anyways, she is going to see a rheumatologist hopefully very soon - and I appreciate your words of optimism - I will pass them on!

Mary