Investigation | Result |
---|---|
C-reactive protein | <10 mg/l (normal range 1-10 mg/l) |
Hemoglobin | 10.7 g/dl (normal range 13-17 g/dl |
Liver and kidney functions | Normal |
Erythrocyte sedimentation rate | 23 mm/h (normal range <30 mm/h) |
Rheumatoid factor | Negative (<15 IU/ml) |
Anti-nuclear antibodies | Negative |
Extractable nuclear antibodies | Negative |
Serum creatine kinase | 56 U/l (normal range 0-195 U/l) |
Lactate dehydrogenase | 326 U/l (normal range 266-500 U/l) |
X-rays of hands, wrists and knees | No erosions, essentially normal |
CT of abdomen, pelvis, thorax and brain | No residual tumor or metastasis |
Technetium-99 bone scan | Slight increased activity in multiple small joints of hands, otherwise normal |
Viral hepatitis serology | Negative |
HbA1C | 5.2% (normal range 4-6%) |
Skin biopsy | Increased fibrosis of the dermis |
Tumor markers CA-125 CA-19.9 CA-15.3 Alpha-fetoproteins |
17 U/ml (normal range 0-30 U/ml) 21 U/ml (normal range 0-31 U/ml) 12 U/ml (normal range 0-32 U/ml) 2 ng/ml (normal range 0-8 ng/ml) |
Albumin | 28 g/l (normal range 35-50 g/l) |
Calcium | 2.18 mmol/l (normal range 2.1-2.7 mmol/l) |
Ferritin | 25 µg/l (normal range 17-360 µg/l) |
Vitamin B12 | 347 µg/l (normal range 160-1000 µg/l) |
|
Muhammad Haroon, being a Specialist Registrar, is seeking a dual accreditation in Rheumatology and General Medicine. He is a graduate of King Edward Medical College Lahore, Pakistan and did his Membership with Royal College of Physicians of Ireland in 2004. He also did his Masters in Sports and Exercise Medicine in 2007. Since then, apart from gaining valuable clinical experience, he has involved himself in audit and research work.
Mark Phelan is a Consultant Rheumatologist at the South Infirmary-Victoria University Hospital, Cork, Republic of Ireland. He has special interest in the field of osteoporosis. He is the Co-Director of Arthritis and Osteoporosis Centre and is contributing to the specialty through his enthusiasm, energy and willingness to teach.
Competing interests: The authors declared no competing interests.
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