Any thoughts about possible arthritis? Ultrasound not picking it up

[TruthorDie]

I’m part of the way through tests for potentially having arthritis. Symptoms of pain and discomfort in my elbows, wrists and hands started last summer. Im 44 and normally in good health. My GP referred me after l reported these symptoms and my rheumatoid factor level from a blood test was 22 (range is meant to be 7-14).

I had my first outpatients appointment with rheumatology a few weeks ago. I had ultrasounds on my hands last week and they said they couldn’t find any arthritis (not sure why it was just my hands they scanned?). Also having x rays, more blood tests and a urine test. Feeling frustrated as lm sick of feeling unwell and it’s been going on for over a year now. Some swelling and redness in my hands -localized to largest knuckle on each middle finger. I have a first cousin with a rheumatoid arthritis diagnosis. My dad and his oldest brother had gout

I’ve begun on HRT for a few months and it’s not made any difference to the pain or the frequency. I take multi vitamins, vitamin D and liquid iron. I am frequently exhausted and lurch for cold to cold and chest infection. Seem to have developed dry skin round my eyes which lm not sure is eczema or dermatitis. But then again that could be just bring busy with young children and working full time. Symptoms started after my children were born (they are twins) and my cousin started with arthritis after her first child was born.

Has anyone got any ideas please about questions to ask or what it could be? Doctor mentioned possible psoriatic arthritis as a diagnosis but needs my test results before he can confirm this. Not sure why my next outpatients rheumatology appointment is going to be but l am just trying to get prepared

Could it be psoriatic arthritis?

I know my friend took a long time to get diagnosed and hope you get some answers soon. Do you have any other autoimmune conditions?

I’m confused as to why the ultrasound didn’t pick up any arthritis

I have psoriasis. Had to have steroids for my IVF to work

Yes, lm conscious there is a lot of diagnostic uncertainty in this area. Glad your friend got their diagnosis in the end

The ultrasound will only pick up any active inflammation, you can see it on the screen. It’s possible your arthritis isn’t active at the moment but it doesn’t mean you don’t have it. It can take a long time to diagnose the specific type unless is is completely obvious with a very bad flare. Keep pushing for one.

Never had an ultrasound for arthritis, I have psoriatic arthritis, have had either MRI or x-ray and anyway if you have psoriatic arthritis you might not yet have any significant joint damage.

Psoriatic arthritis can be tricky to get a diagnosis b/c it can be present without any signs in your blood.

You should note down all your symptoms before you see the doc - if you've ever had iritis/uvuetis that's also a symptom as well as skin problems as I was surprised to find out for myself.

Good luck!

Thanks for clarifying that about the active inflammation -l wasn’t aware of that. Im
conscious that a diagnosis most likely will take time. I was worried the lack of arthritis in the ultrasound might to me being discharged

Lots of skin problems -lm quite a rashy / itchy / allergic kind of person. Like l said in my original post l have already seen the doctor at rheumatology outpatients, waiting for the next appointment date

Never knew that about iritis/uvuetis so noted. I have my eyes tested a couple of months ago and no issues were reported by them

I have found Versus Arthritis to be a good source of information on all sorts of conditions.

It does sound like it. I've had ultrasounds and x-rays on my hands, which apparently shows that they're fine. They're really not.

I also get very dry eyes. I really struggle with contact lenses. I have developed iritis in the past with them.

It's quite disheartening to be told scans are saying there's nothing wrong with you. I recommend keeping a diary of your symptoms along with pictures of any swelling or redness to show to your rheumatologist next time.

Are you getting any stomach troubles?

I’m part of the way through tests for potentially having arthritis. Symptoms of pain and discomfort in my elbows, wrists and hands started last summer. Im 44 and normally in good health. My GP referred me after l reported these symptoms and my rheumatoid factor level from a blood test was 22 (range is meant to be 7-14)

I would be wary of reading too much into the rheumatoid factor level. It is an indicator and is looked at alongside all the other information.

I had similar issues with my hands, wrists lower arms and elbows with swelling and continual tingling and low level pain. Even though I wasn't ill otherwise they still checked for RA. The end result was that it was probably to do with my upper spine and nerve root irritation. It suddenly subsided after a couple of years and isn't too bad now. Taking ibuprofen helps a lot.

The ultrasound isn't diagnostic, in that it can't say you have no underlying condition, it could only point to swelling that day and whether or not you needed specific treatment. If you need steroids in your joints, for example, they use ultrasounds to identify the specific joint with fluid in and guide the needle in.

Also, the X-rays you will likely get are baseline tests, used to gauge the level of damage sustained over time. Hopefully they will show nothing yet - that doesn't mean you have no condition. I've had RA 20yrs, my hand X-rays are still fine.

Sjogren's often a co-morbidity with women in their 40s with arthritis, which would lead to dry skin round your eyes. Even if your eyes feel wet, that can indicate a lack of oil in your tears and actually be dryness, don't rule out asking the optician about it.

I think you are being treated as having an underlying inflammatory arthritis, but perhaps not reaching the threshold for treatment yet. Keep going with the GP, point to the fatigue as well as the swellings as affecting your life, is it worst in the mornings?

Don't get swept up in which type of arthritis, psoriatic or rheumatoid are not that different, often overlap and receive the same treatments. Good luck.

I forgot to say I am otherwise fit and healthy. I'm a good weight and I exercise and don't drink.
I think peripheral neuropathy can be caused by lots of things including diabetes etc. My hands are buzzing right now 😭😭😭

BTW I'm not the least bit medically trained!

I have seronegative RA, mostly affecting hands, wrists and elbows. Xrays are clear and ultrasound showed very little, but MRI confirmed significant synovitis and led to RA diagnosis.

Thanks for the tip, l will take a look

What kind of stomach troubles? I used to have an IBS diagnosis but seems a lot better these days

Thanks. I’m waiting for my 2nd outpatients appointment, dreading if l get discharged as l had to prompt and remind my GP a lot to get to this point -they weren’t following NICE guidelines, referred me to the wrong hospital etc. Not noticed any patterns of it being worse in the morning? I work in healthcare in a field that has a lot of diagnostic uncertainty and from the research l have then l know arthritis can be like that. I just want to feel better and hopefully not get worse rather than get overly focused on a diagnosis

I have psoriatic arthritis and developed it around your age. Never showed up on bloods, X-rays, mri ir ultrasound but a good who specialises in psa can feel swelling.
I don’t have any rashes either.

Rheumatologist I meant to say

@TruthorDie did they ever investigate a potential lupus diagnosis? My mum has lupus sle and one of her flare symptoms is that it mimics RA in her hands and other joints (also tends to lower her platelets but that's separate)

My daughters GP kept saying my daughter had arthritis.. she went to two rheumatologist who were stumped after scans/ tests .
The third was amazing and diagnosed her with Ehlers-Danlos syndrome/ Hypermobility.

OP I have psoriatic arthritis and symptoms very similar to your. It took a good while to get diagnosed. All blood tests were fine, got xrays on hand, feet and pelvis and told all fine. I said how can they be fine when I can see clear bony deformities on my hands that are getting worse, was told they are just looking for joint damage not the deformities.

I have carpal tunnel syndrome also which was causing some of the hand/wrist symptoms.
My issues were random pains in joints, fine one minute throbbing the next, fatigue, headaches, digestive issues/IBS, psoriasis, tendonitis recurring in different areas. My knuckle joints would swell and fingers have thickened. I have bone spurs/nodules on a lot of joints.
My rheumatologist trialed me on methotrexate to see if I responded to it which I did. Been on it 6 years now

I also have psoriatic arthritis and had pretty much the same experience as @Rumors1

That’s interesting. It seems to take a long time to get a diagnosis.

How are you doing OP?

I had to check if I'd written this! OP I hope you're getting some support - I'm awaiting results of x rays and a knee MRI

Thanks for checking in. No change here really, my hands got bad and then improved. Wrists and elbows are variable. At my first appointment l was told they would see me again in 8 weeks which would have been last week. I chased them the other week but they said the appointment would be mid or late September. Im going to wait until the start of October and then contact rheumatology again