Finger and Wrist Pain: Is It Rheumatoid Arthritis?

Q: Finger and Wrist Pain: Is It Rheumatoid Arthritis?

Hello, thank you for your message. <br>Here are the responses to your questions：<br>1. <br>Regarding the fluctuations in your Anti-CCP test results： On March 7, the hospital test was normal; on April 20, your self-test showed a significantly elevated level; however, on April 24,

Regarding finger and wrist pain associated with rheumatoid arthritis?

Dear Dr.
Gao,
Hello.
Last June, during a routine check-up, I unexpectedly found out that my RF factor was positive.
Subsequently, I visited the hospital, where the doctor arranged for additional blood tests.
The most recent test was conducted on March 2021.
The test items and results are as follows: RF: Positive 16.3 (reference value <14.0), CRP: <0.03 (reference value <0.5), ANA: Negative, Ribosomal: Positive (this item is positive, but the doctor did not provide an explanation for this), Anti-CCP: <7 (reference value <17).
The doctor informed me that there were no issues with the above results and advised me to return for a follow-up in six months (as the rheumatoid factor is positive and needs monitoring).
However, since early January of this year, I have been experiencing pain in my right shoulder, which has persisted.
It is particularly painful to touch, making it impossible for me to sleep on my right side.
Since late April, I have also been feeling pain in my right elbow and wrist, and starting from the end of April, my right palm, the area below my thumb, and other fingers on the right side have been painful.
At times, the pain in my palm and fingers is severe, accompanied by tingling and weakness.
In early May, I began experiencing similar sensations in my left palm, wrist, and fingers.
I can hardly do housework or use the computer.
After two weeks of rest, the pain has somewhat diminished, but my wrist and fingers still ache (the middle finger, ring finger, and the middle and palm-side joints of the thumb still have tenderness and pain at certain angles).
My right foot's sole and toes (index, middle, and ring toes) also experience pain.
Due to the current pandemic alert and not yet reaching the follow-up time suggested by my doctor, I am uncertain about what to do.
I am also unsure if I have rheumatoid arthritis or something else.
I have researched online, and it seems that the blood test for rheumatoid arthritis is Anti-CCP, so I went to a testing facility to have my blood drawn again.
The results are as follows: On April 20, Anti-CCP: Positive 10 (reference value <1.5-1.93).
On April 24, I went to another facility for testing, and the result was Anti-CCP: Normal 1.90 (reference value <7.0 (-), 7-10 Equivocal, >10 (+) EliA U/Ml).
Since the pain has not completely subsided, I am unsure whether I should return for a consultation or continue to wait.
On May 25, I had another blood test, and the report showed RF Quantitative: Positive 16.8 (reference value <14.0), Anti-CCP: Positive 6.91 (reference value <1.5-1.93).
The staff at the testing facility indicated that this is quite high, which suggests a diagnosis of rheumatoid arthritis.
I would like to ask Dr.
Gao the following questions:
1.
Regarding the Anti-CCP tests, why do the results fluctuate? The hospital test on March 7 was normal; the self-test on April 20 was significantly elevated; the test on April 24 at another facility was normal again; and the test on May 25 was elevated.
Could the differences in results be due to variations in the units of measurement? (It seems there are two different units of calculation.) Am I suffering from rheumatoid arthritis?
2.
I noticed that the Ribosomal test was positive, but the doctor did not explain this part.
I couldn't find relevant information online.
What does this test entail?
3.
What should I do now? Are there any additional tests that can help determine if I have rheumatoid arthritis? Should I seek a follow-up appointment immediately?
I hope Dr.
Gao can take the time to clarify my concerns and provide me with some advice.
Thank you very much!
A concerned patient.

Ivy, 40~49 year old female. Ask Date: 2021/05/26

Dr. Gao Jiankai reply Internal Medicine

Hello, thank you for your message.
Here are the responses to your questions:
1.
Regarding the fluctuations in your Anti-CCP test results: On March 7, the hospital test was normal; on April 20, your self-test showed a significantly elevated level; however, on April 24, another facility reported normal results again; and on May 25, the test showed elevated levels once more.
Could the differences in results be due to variations in the units of measurement? (It seems there are two different units of measurement for the results.) Should I be concerned about having rheumatoid arthritis? --> Test results can vary over time, and it is advisable not to check the CCP levels too frequently, as this may increase your anxiety.
Additionally, an RF value is more meaningful when it is at least four times above the normal upper limit, so while your RF is elevated, it may not be significant.
The diagnosis of rheumatoid arthritis involves not only blood tests but also inflammatory markers such as CRP and ESR, and most importantly, clinical symptoms.
Therefore, I recommend consulting a rheumatologist for further evaluation.
2.
I noticed that the "Ribosomal: Positive" result on my health insurance statement is positive, but the doctor did not provide an explanation for this, and I couldn't find relevant information online.
What does this test entail? --> Ribosomal antibodies may be associated with lupus; however, similar to the previous point, it is essential to correlate this with clinical symptoms and other blood test results.
You should discuss this further with your rheumatologist.
3.
What should I do now? Are there additional tests to determine if I have rheumatoid arthritis? Should I schedule a follow-up appointment immediately? --> If you are concerned, you can schedule a follow-up appointment right away.
As for the diagnosis of rheumatoid arthritis, please refer to the answer provided in question one.
The Allergy, Immunology, and Rheumatology Department at Changhua Hospital is here to support you.

Reply Date: 2021/05/26

More Info

Dear Patient,
Thank you for reaching out with your concerns regarding your symptoms and the potential diagnosis of rheumatoid arthritis (RA). It’s understandable to feel anxious given the complexity of your situation, especially with fluctuating lab results and persistent pain. Let’s address your questions and provide some clarity.

1. Fluctuating Anti-CCP Results: The Anti-Cyclic Citrullinated Peptide (Anti-CCP) test is a specific marker for rheumatoid arthritis. However, it’s important to note that lab results can vary due to several factors, including the specific testing methods used by different laboratories and the timing of the tests. Variations in results can occur due to differences in assay sensitivity and specificity. It’s also possible for the disease to be in a state of fluctuation, which can affect the levels of these markers. Given that your RF (rheumatoid factor) remains positive, it does suggest a potential for RA, but it is not definitive on its own. The presence of symptoms, particularly symmetrical joint pain and stiffness, alongside these markers, would be more indicative of RA.

2. Ribosomal Positive Result: The ribosomal P protein antibodies are not commonly discussed in the context of rheumatoid arthritis. They are more often associated with systemic lupus erythematosus (SLE). The significance of a positive ribosomal P antibody can vary, and it is best to discuss this with your rheumatologist for a more tailored interpretation based on your overall clinical picture.

3. Next Steps: Given your ongoing symptoms, including pain in multiple joints and the impact on your daily activities, it would be prudent to follow up with your healthcare provider sooner rather than later. Persistent joint pain, especially with a background of positive RF and fluctuating Anti-CCP results, warrants further evaluation. A rheumatologist can perform a comprehensive assessment, which may include additional blood tests, imaging studies (like X-rays or ultrasounds), and a thorough physical examination to assess joint inflammation and damage.

In the meantime, consider the following supportive measures:
- Rest and Activity Modification: Avoid activities that exacerbate your pain. Gentle range-of-motion exercises can help maintain joint function without overstraining.

- Pain Management: Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) can help alleviate pain and inflammation. However, consult your doctor before starting any new medication.

- Heat and Cold Therapy: Applying heat or cold to affected areas can provide symptomatic relief.

- Physical Therapy: A physical therapist can design a program tailored to your needs, focusing on strengthening and flexibility.

It’s crucial to maintain open communication with your healthcare team. If your symptoms worsen or new symptoms arise, do not hesitate to seek immediate medical attention. Early intervention can significantly impact the management of rheumatoid arthritis and improve your quality of life.

In conclusion, while your lab results and symptoms suggest a possibility of rheumatoid arthritis, a definitive diagnosis requires a comprehensive evaluation by a rheumatologist. Please prioritize scheduling a follow-up appointment to discuss your symptoms and lab results in detail. Your health and well-being are paramount, and timely intervention can lead to better outcomes.

Best wishes for your health,
Doctor Q&A Teams

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