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An_246691 posted:
OK guys & gals. I'm counting on you.I'm a bit freaked out since my appointment with the rheumatologist's PA 2 weeks ago & I go back tomorrow.I started with feet, then hands, then elbows.I requested blood work results and saw that it's normal.I don't understand how the sed rate can be normal if I have inflammation (stiffness so I couldn't walk in a.m. or make a fist) Only had those symptoms and signs for about a month so x-rays were also normal.I took Prednisone since appointment and the second day I was normal & could wear shoes I hadn't been able to because of swelling for over a year.Do you think I can still RA or is it something else?
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Scott Zashin, MD responded:
Patients may have normal measures of inflamamtion with RA. Unless a patient has high levels of RF or CCP, I often do not diagnose RA for at leaset 6 weeks as viral illness can cause pain and swelling of joints. Parvovirus is a common type of viral arthritis and can be confirmed by finding a positive Parvo IgM antibody in the bloood. The presence of a Parvo IgG antibody without an IgM antibody shows a prior infection and goes against Parvo as the cause.
 
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An_246691 replied to Scott Zashin, MD's response:
Thank you, Dr. Zashin.My PA is saying it's really abnormal to not have a high sed rate but is still sure I have an inflammatory condition.Forgot to ask me if I had Raynaud's last time (which I do).Started me on Plaquenil and suggested low dose Prednisone, which I'm holding off for right now & I return in 6 weeks after getting new bloodwork.Some new tests ordered.Hopefully this time will get me a definite Dx.I know how hard that can be.I'm so glad I found this site.I think I will be needing the support of all these comrades.
 
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Scott Zashin, MD responded:
I can't give you a number, but I have patients with active RA who don't have an increase in ESR or CRP, another measure of inflammtion. I feel the CRP is a better marker for possible joint damage than the ESR, but I use both to help me with my treatment decisions. Glad you are doing well.
 
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Scott Zashin, MD replied to An_246691's response:
Raynauds is not common with RA. I will diagnose my patients with a postive ANA, raynauds and swollen joints to have an undefined connective tissue disease. I use Plaquenil commonly in this situation.


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