Question 1

Dear Doctor, A patient aged 70 has been experiencing continuous pain and swelling in the upper right foot and toes for the past month. There is no history of diabetes or high blood pressure. Recent investigations show: Blood report: normal, X-ray: normal, Vitamin D: normal, Uric acid: normal and NCV (both lower limbs): normal. The pain temporarily subsides with painkillers but returns after a few hours. Could you please advise what further tests or evaluations are recommended and how we can diagnose the cause? Thank you.

Question 2

I got a full body checkup and need an opinion on the rheumatoid factor normal range value. My report mentioned: Rheumatoid Factor Quantitative less than 20.0 IU/mL, less than 30 Normal, 30 to 50 Weakly positive, greater than 50 Reactive. Is this normal? Some sites say that up to 14 IU/mL is normal and more than 14 is high. Please advise.

Question 3

My wife has pain in her wrists, hands, finger joints, and shoulders. She is 33 years old. Her recent test results are: RA factor positive, CRP positive, ESR 14 mm/hr (normal range 0 to 20), vitamin D, uric acid, calcium, and other tests are normal. She has not done Anti CCP antibody test yet. What are the next steps? We are worried because her RA factor is positive.

RA factor mildly raised, along with joint pain, needs anti CCP to confirm early rheumatoid arthritis. Pain worse at rest, better with movement, supports inflammatory arthritis. Use NSAIDs till diagnosis.

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