An 8 yr old boy with an arthritis affecting both elbows and his left ankle. Marked pain swelling and restirction of movement.
symptoms and inflammatory markers settling after a course of herbal medicine and anti-inflamatories.
Bloods: 6/9/08:
CRP: 384 mg/L
ESR: 55
Rheumatoid factor: Positive
30/11/08
CRP: "negative"
ESR: 40
Rheumatoid factor: Negative
WCC: 8.9
I'm not sure how reliable the labs are nor what a constitutes a negative CRP?!
On examination he has marked swelling of a his right elbow and right ankle, only a little warm to the touch and moderately painful on all movements. Just about a ful range of movement at both.
Also He has an ejection systolic murmor radiating to his carotids, with no signs of symptoms of heart failure.
What is the next step: all ideas welcome............... further questions............?
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I know the answer - he has lupus!!!! I knew I should be a doctor!
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