I am a 30 year old male. No history of autoimmune disease in the family.
My symptoms are basically strong joint pain in the fingers, wrists, feet, toes, and knees. The pain began in February and has continued until now. It is worse at nights. I have a very small amount of morning stiffness, not much at all. Some days I have no detectable morning stiffness.
I am under the care of a rheumatologist. Here are my results. RF = negative, Anti-CCP = negative, CRP = negative, ESR = 7 (negative). X-ray = negative for joint damage and inflammation. MRI with contrast = negative for synovitis and tenosynovitis, negative for inflammation, reported as "no objective signs of RA." My rheumatologist has conducted the "squeeze" test and has not been able to detect any swelling or inflammation in my fingers. So she is reluctant to proceed with RA treatment.
There is one other confounding variable. I was found to have a positive ANA (1:40) and elevated Thyroid antibodies ( > 1000). My TSH was tested and was high out of spec at 6.1, however I have no symptoms of hypothyroidism other than the joint pain. No fatigue, no constipation, no brain fog, no weight gain, no brittle nails, etc.
My question for the group is, how likely is it that this could be RA without there being any objective evidence? I understand that the blood work comes back negative in about 20% of RA patients. Is the same true for inflammation? In other words, do RA cases at times present themselves with pain but no objective signs of inflammation? Have any patients here experienced a similar manifestation of joint pain? If so, what did the issue turn out to be? Thanks for any answers.
I am considering getting thyroid treatment to lower my TSH levels to see if that helps the joint pain, but I am skeptical given that I have no other hypothyroid symptoms. Also, I really don't want to screw around with my thyroid until I have to.
Without the ability to show doctors at least *some* kind of objective evidence for RA (rather than symptom report), it seems that few doctors will want to go the route of prescribing a DMARD. At the same time, my fear is that I am in an early window of RA that could have a very good outcome if I act now, and that by experimenting with other possibilities (i.e,. taking thyroid meds for a month to bring down TSH and see if that helps the joint pain), I am compromising that window.
Any comments or advice is greatly appreciated,
Post Edited (ratobranco) : 4/23/2011 9:10:20 PM (GMT-6)