Raised rheumatoid factor- what else can it mean?

[thaneofglamour]

I went to my GP at the end of December because of agonising pain in my left second toe and some pains in my hands.

He sent me for a blood test that was all fine apart from an elevated rheumatoid factor. Not hugely raised - it was 24.

So he requested x rays on my hands and feet and referred me to rheumatology. Even before X ray results came back I got a snotty sounding letter from Circle Healthcare which counts for being 'seen in clinic' these days. This letter implied that the raised RF means nothing without symptoms (errrmmmmm - I wouldn't have gone to GP without symptoms??) but to 'reassure' I should have an ultrasound (hands only, not feet).

Meanwhile the X ray came back which did show numerous signs of growing gaps between joints in hands and feet. I then had the US which came back normal. I am now at the 'take paracetamol' advice and 'you can have physio if you want'. I do have some recent experience with medical gaslighting which may influence my response to this but I can't understand how the pains in hands and feet and an abnormal x ray along with a raised RF can't signal something.

Dr Google tells me that other reasons for raised RF are other auto immune disease, some cancers , diseases I definitely don't have such as HIV ,and ageing. However, it suggests that a raised RF is mainly found in the elderly. I'm not elderly! Although the pain in toe sent me to the GP I do have multiple painful joints and often very fatigued.

Has anyone got any experience or insight with this? I have asked to see GP again but would like to go armed with any advice.

Do you have any results for CRP or ESR ? These are inflammatory markers which could indicate an inflammatory arthritis such as RA. Any signs of psoriasis ?

Do your hands hurt when squeezed ? Any stiffness in the morning ? Stiffness lasting more than half an hour is generally a sign that there’s something more than osteoarthritis going on.

i don’t think it’s unreasonable for you to ask to see a rheumatologist as they can often feel the changes in the various joints. RA and other inflammatory arthritis benefit from an early diagnosis and treatment plan so don’t feel bad about pushing to have these ruled in or out.

My ultrasound showed nothing and my rheumatologist is very much of the view that it’s very much dependent on the technician and whether there is active inflammation on the day of the scan and in the area of the scan. In other words, ultrasounds are not definitive.

Stiffness, fatigue, multiple joint pain, symmetrical pain in hands, pain in hands and feet, raised RF, changes visible on X-rays are all justifiable reasons for a physical review by a rheumatologist. It’s a busy service but very much one where diagnosis needs a physical exam.

How old are you OP, if oyu dont mind saying?

Hello all. Thanks for replying. I appreciate it.

To answer questions:

My hands don't hurt when squeezed but my grip is not as good as it once was. When I wake up in the morning, my joints are quite stiff but not too bad. I often wake up with my fists and jaw clenched. My neck is very painful but that's been a long term issue. My skin keeps going red on my palms and across my knuckles but there's no visible swelling. I feel like my hands are a bit weak and my wrists hurt sometimes but I use a laptop all the time for work.

My CRP and ESR were fine. I haven't had one of the anti CCP tests I have read about.

I am guessing rheumatology are very busy because my letter counts as me having been 'seen in clinic ' apparently!

I don't think my pian is symmetrical - at least not in feet . But the x ray definitely showed symmetrical deteriorations. I have no idea why my feet have been so overlooked!

To answer the age question - I am in my early 50s.

What would be signs of psoriasis?

Rheumatology waits in my area are over a year so I can see why they're filtering out.
With normal crp and ESR and only a slightly raised RF I'm not sure they would treat even if it was rheumatoid arthritis.

To me (recently diagnosed with psoriatic arthritis) it does sound like there's enough indications of inflammatory arthritis to warrant an actual assessment by a rheumatologist. Best practice guidelines for suspected early inflammatory arthritis are that it's supposed to be an urgent GP referral and then seen within 3 weeks by rheum... when I last checked this was achieved in around half of NHS trusts.

Re: psoriasis, do you have a flakey scalp or any pitting, lifting, or crumbling of your nails? You can Google for what psoriasis looks like but it can hide or be missed if it's mild or mistaken for something else(eg dandruff or fungal nails). RF isn't typically raised for psoriatic arthritis, but can be for a small minority.

I ended up going private and saw a fab rheum who diagnosed me and also advocated on my behalf with my GP and local NHS rheum team.

No , none of those psoriasis signs, thankfully.

I understand what you mean @MyBestThing - but on the other hand I keep reading about the benefit of catching things early.