Dr. Keith Roach

DEAR DR. ROACH: Is there a possibility of having some type of rheumatoid arthritis (RA), even though it doesn’t show up clearly in the blood work? (My CRP level was 0.3, rheumatoid factor was 10, anti-CCP result was 15 u/mL, and ANA test came out negative.) I have symptoms that I feel I am not getting treated for because of this. I have other autoimmune symptoms such as Raynaud’s and extreme foot inflammation that makes it difficult to walk, along with joint pain and stiffness pretty much all over.
My concern is that I’ll have continued joint damage if I don’t get treated. It seems like something else begins to ache every week, making movement difficult and causing low energy levels. I want to get more active again. I love to garden, but it is a fight to push myself through.
I convinced my doctors at the beginning to try a Medrol Dosepak, which helped calm all the inflammation, but they will not prescribe it again because they say I don’t have RA.
As a woman, I feel that I don’t get treated as aggressively as my husband does. He receives answers right away, whereas I have to call and wait days. My pain is ignored with “Just take Tylenol.” I’m not asking for narcotics, just a way to get the pain under control so I can function day-to-day. Am I just getting “old” (I’m 63), and should I “just bear it,” as I was told?
It seems doctors don’t spend enough time getting to know their patients or explaining things. Physicals are not thorough anymore. — C.T.
ANSWER: Not every patient with RA will have diagnostic blood tests. Blood tests may not be positive early on in the course of the disease, and a minority of people will have RA diagnosed, even though they never have positive blood test results. The diagnosis can be made by an expert when other conditions are met.
A careful exam should show a large number of swollen small joints, symmetrically distributed (i.e., both the left and right side have the same joints affected). Your concern about joint damage is very important. X-rays of the affected joints (usually hands, but feet, too, if symptomatic) may show joint erosions or rheumatoid nodules, both of which will make the diagnosis much more likely.
It always makes me angry to hear a patient’s concerns about getting ignored because of older age (and 63 isn’t even old!), being female or a person of color, or being overweight (all of which are well-described in medical literature). I cannot tell whether you have RA, but I do think you deserve a careful evaluation.
Making a diagnosis (if not RA, then whatever else is causing your symptoms) is critical before getting treatment with drugs that can cause long-term complications, like the Medrol (a brand of methylprednisolone — a corticosteroid).
I recommend consultation with a rheumatologist, and I suspect a careful exam and X-rays are in your future.
DEAR DR ROACH: Regarding your recent column on iron deficiency, my blood bank told me drinking tea somehow negatively affects iron. I’d love an explanation, as this could be a possible cause behind the low iron levels of the 82-year-old mentioned in the column. — F.O.
ANSWER: Drinking large amounts of tea with meals does reduce iron absorption, particularly the iron found in grains and vegetables. Coffee also reduces iron absorption, but the effect is greater with tea. A class of compounds found in tea (tannins) bind with the iron, preventing absorption. It is possible, but unlikely, that tea alone is responsible for low iron levels in most people. Tea that is drunk two hours away from a meal will not affect iron absorption.
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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.
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