Question
I am 39 years old anaesthesiologist.I have been experiencing pain in both knees for the last three years.There has never been a swelling.I remain fatigued throughout the day.I am also having pain in the upper back for the last eight years that subsides on resting.I have chronic maxillary sinusitis for which middle meatus antrostomy was done three years back.My small joints are not involved.I am also having Gastroesophegeal Relux for which I regularly take Pentaprazole. Investigations show that Rheumatoid factor is positive,ANA is positive .ESR is always above 30. C-Reactive protein is negative. CBC is within limits.Uric acid level is normal. What more investigation you advice to reach at the diagnosis?Tell me the safe analgesic which can be given keeping in view of GERD. If DMARDS is advised then Whch one?
Answer
The critical question is whether you have rheumatoid arthritis. Your description raises some doubts. An MRI scan of the knees might be useful to see if there is evidence of bone erosions or chronic synovitis that would be hallmarks of RA. In general DMARDs should be started once the diagnosis of RA is secure. Most would consider starting methotrexate unless there are contraindications to its use.
