Health Decision Guides

Welcome to the Positive Rheumatoid Factor (RF) Guide.

This decision Guide is designed for persons with a positive rheumatoid factor (RF) who would like to find out more about this test and what the result may mean.

The goal of this guide is to provide information while awaiting evaluation with your doctor, or for additional information after you have seen him or her. Please keep in mind that this guide is not intended to replace a face-to-face evaluation with your doctor. The diagnoses provided are among the most common that could explain your symptoms, but the list is not exhaustive and there are many other possibilities. In addition, more than one condition may be present at the same time.

The first thing to say is this: don't panic! The test is not so accurate that its result clearly means anything at all! Depending on your symptoms and the reason the test was ordered, the importance (or lack of importance) of your test result can usually be determined.

Would you like more information about the RF test in general, or would you rather proceed directly to what your RF may mean?

I'd first rather get more general information about RF.

I'd like more specific information about my RF.

The RF is an antibody detectable in the blood in about 70 percent of persons with rheumatoid arthritis but can often be found in other people as well. In fact, healthy people with no arthritis and no medical problems at all make tiny amounts of this antibody. In 90-95 percent of young, healthy persons, the amount of RF present in the blood is so low that it is considered absent from the blood and the test is considered negative (the "normal" result).

The number of healthy people having a positive RF rises somewhat with age, although sicker elderly people tend to have a positive RF more often than the healthy elderly. Also, when the RF is positive without disease present, it is usually only slightly positive, while higher levels are more likely to indicate "true" disease of one sort or another. See below for conditions other than rheumatoid arthritis associated with a positive RF.

Other conditions associated with arthritis may result in a positive rheumatoid factor: Sjogren's syndrome and systemic lupus erythematosus are good examples, but these conditions usually cause other symptoms and blood test abnormalities that provide clues to the diagnosis.

Certain infections, including endocarditis, viral infections, and others may trigger RF production by the body's immune system. Once the infection passes, repeat RF testing usually reveals negative results. Hepatitis C, a viral infection of the liver, is one of the more common ones, especially when a protein called "cryoglobulin" is present. This infection can be chronic (long-standing) so the RF may remain positive.

Three other situationsdeserve mention:

• People who tend to make one "autoantibody" (an antibody created against a part of one's own organs or tissues) may make others; so if you have an "autoimmune" condition, such as certain thyroid diseases or even type 1 diabetes, you may be more likely to make RF even without an associated disease.

• People with a family history of rheumatoid arthritis (or other RF-associated disorder) are more likely to have relatives with a positive RF, even if no disease is present.

People "destined" to develop rheumatoid arthritis may have a positive RF detected years before they develop symptoms or signs of the disease. However, of all people with a positive RF and no joint symptoms, the vast majority are thought to remain free of RF-associated disease over time.

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I'd like more specific information about my RF.

Welcome to this Guide about problems with vision. We're sorry you're having this problem!

Please keep in mind that this information cannot replace a face-to-face evaluation with your own health care provider. It is meant to provide helpful information while you are awaiting further evaluation or to supplement what you may have already learned after evaluation with your doctors.

Are you having any eye pain or eye discharge?

Yes, I have one of these symptoms.

No, I have no eye pain or discharge.

Before you are asked a series of questions about the details of your symptoms, it is important to determine whether you have a condition that warrants immediate, urgent or emergency care. For example, a sudden loss of or change in vision deserves prompt evaluation by your doctor.

Have you noticed the sudden onset of any of these symptoms:

• vision loss

• seeing double (or double vision)

• the feeling of a shade over the eye

• lights are surrounded by halos

• light sensitivity?

Yes, I am experiencing one or more of these symptoms.

No, I have not noticed any of those symptoms.

It's not uncommon for children of all ages to develop a rash. Most rashes are not cause for concern, but some rashes need a doctor's attention.

Answering the questions in this health decision guide will help you understand more about common childhood rashes, and help you know when to contact your doctor for medical care. If your baby is less than one month, visit our guide on Rashes in Newborns.

Please note, this guide is not meant to take the place of a visit to your pediatrician's office.

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Infections, with bacteria or viruses, often cause rashes. Some of these infections are more serious than others. Fever is another sign of infection.

Which of the following statements describes your child?

My child has a rash and a fever.

My child has a rash but has not had a fever.

My child has a rash that started after a fever went away.

Welcome to the Raynaud's Decision Guide.

We're sorry to hear you have Raynaud's!

The goal of this guide is to provide information while awaiting evaluation with your doctor, or additional information after you have seen him or her. Please keep in mind that this guide is not intended to replace a face-to-face evaluation with your doctor. The diagnoses provided are among the most common that could explain your symptoms, but the list is not exhaustive and there are many other possibilities. In addition, more than one condition may be present at the same time. For example, a person with Raynaud's could also have osteoarthritis that is unrelated.

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This guide is intended for persons who have Raynaud's -- you may hear it called Raynaud's phenomenon, disease, or syndrome. Whatever the name, the basic problem in this condition is vasospasm -- that is, a blood vessel (the "vaso" part) suddenly constricts (the "spasm" part), usually after exposure to cold. Then, not enough blood can flow to the finger, toe or whatever part is affected. This is an exaggeration of the normal behavior of blood vessels. Tiny nerves tell the artery to open or close, depending on the situation. Usually with cold exposure, blood vessels constrict, or close a bit, to conserve heat, but for people with Raynaud's, that mechanism is overactive. The cause is not known. People with Raynaud's notice intensely cold fingers or toes, numbness, pain, and a color change -- typically from white to blue to red, and, eventually, back to normal, over a number of minutes.

Most people with Raynaud's (up to 90 percent or more) are otherwise healthy and have no other medical conditions. Raynaud's is quite common -- up to ten percent of healthy young women report symptoms suggestive of Raynaud's. The associated conditions, on the other hand, are rather rare, and include lupus, scleroderma and CREST syndrome, among others. There will be an opportunity to learn more about these conditions at the end of this guide.

Now, let's move on to the specifics of your situation.

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Welcome to the Decision Guide for Rectal Pain or Itching.

This guide can help you to identify some of the causes that are most likely to explain your symptoms and to anticipate the recommendations that your doctor might make.

Rectal itching or minimal rectal pain can occasionally occur during normal bowel movements. However, significant rectal pain or persisting rectal itching is not normal and can sometimes be caused by a serious medical problem. For significant pain or persistent skin irritation around the rectum, you should always seek an evaluation by your doctor. This guide is intended to be used as a complement to discussions with your doctor, not as a substitute for office-based care.

If your major symptom is rectal bleeding, constipation, or diarrhea, you may find it more helpful to consult our other Health Decision Guides.

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Women and men will have some issues that differ.

Please choose:

I am a woman.

I am a man.

Welcome to this Decision Guide on Sexual Problems in Men.

Almost all men will experience one or more sexual problems at some point in their life. Fortunately, many of these problems will improve on their own over a short period of time. This guide is intended to help you understand why you may be experiencing a particular problem, and what can be done to help.

If you are experiencing a persistent or particularly troubling problem, be sure to see your health care provider. Keep in mind that treatment is available for many different sexual problems. This guide is intended to provide helpful information while you are awaiting further evaluation, or can add to what you may have already learned after your visit with a doctor. Remember that this guide cannot substitute for an individual evaluation by your health care provider.

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There are many different sexual problems that men can experience, including

• low sexual drive

• problems with erections, including difficulty getting or keeping an erection, and curvature of the penis during an erection

• problems with ejaculation, including early ejaculation, delayed ejaculation, and "dry" orgasm

• pain in the penis or elsewhere during intercourse.

Each of these problems may have several different causes. In order to get started, we need to find out more about your specific problem.

Pick one the statements below which best describes your sexual problem. If you have more than one of these problems, choose the most bothersome one and return to this guide later to learn more about the others.

I have low sexual drive.

I have difficulty with erections.

I have problems with ejaculation or orgasm.

I have pain during sex.

I have a different sexual problem.

Welcome to our Health Decision Guide on Shortness of Breath.

By answering a short series of questions, you will learn about the possible reasons why you have recently developed mild to moderate shortness of breath.

Severe shortness of breath and shortness of breath accompanied by certain symptoms requires immediate medical attention. If you have one or more of the following symptoms, it is a medical emergency:

• severe shortness of breath

• difficulty talking in full sentences

• chest pain with shortness of breath

• swelling in the face or abdomen with shortness of breath (a possible allergic reaction).

Do you have any of the symptoms listed above?

Yes, I have one or more of these symptoms.

No, I don't have any of these symptoms.

That's good. However, even if your symptoms are not severe, difficulty getting air in or out of the lungs is a symptom that always requires evaluation by your doctor.

Now you are ready to start the guide.

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If your child cannot seem to get enough breath in his lungs (shortness of breath) or is having a hard time breathing, he probably has a medical condition that needs treatment. If your child is old enough to talk, he can tell you that he is having difficulty breathing. If your child is younger, you may notice that he is breathing harder or faster than usual, isn't feeding well, or is cranky. Seek emergency medical care immediately if your child is in severe distress -- no matter his age.

Answering the following questions in this Health Decision Guide will help you understand more about what usually causes shortness of breath in children, and help you know when you should contact your pediatrician for medical care. Please note, this guide is not meant to take the place of a visit to your pediatrician's office.

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Shortness of breath can be a sign of a serious illness.

Your child is having some difficulty breathing. Do any of the following other statements describe your child?

• When my child breathes, I can see his nostrils flare, his belly move out, his ribs stick out, and/or his neck muscles tighten.

• When my child breathes in, he makes a whistling or high-pitched noise.

• He grunts when he breathes out.

• His lips, mouth or fingertips are blue.

• He can not talk or can not finish a sentence without stopping to take a breath.

• He is drooling more than he usually would.

• His face, lips, eyes, or neck is swollen.

• He is scratching or has hives.

• He is sleepier than usual for the time of day.

• He is not moving normally.

• He is not answering questions normally or seems confused.

Yes, one or more of these statements describes my child.

No, none of those statements describe my child.

We're sorry you have shoulder pain!

The goal of this guide is to provide information while awaiting evaluation with your doctor, or for additional information after you have seen him or her. Please keep in mind that this guide is not intended to replace a face-to-face evaluation with your doctor. The diagnoses provided are among the most common that could explain your symptoms, but the list is not exhaustive and there are many other possibilities. In addition, more than one condition may be present at the same time. For example, a person with rheumatoid arthritis could also have tendonitis.

The shoulder is prone to developing pain in part because its anatomy is complex and because it has the largest range of motion of any joint in the body. Some of these muscles, tendons, and bursae are common causes of shoulder pain, even when the joint itself is fine.

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Do you have severe shoulder pain with the following symptoms:

• fever

• redness

• marked swelling

• inability to use the joint

• recent significant trauma (a fall, car accident, etc.)?

Yes, one or more of these is true.

No, I have had none of the above.

Welcome to this symptom guide regarding loss of smell and/or taste. We're sorry you're having this problem!

This symptom guide is designed for persons who have noticed problems with smell or taste (or both) and would like to find out more about these symptoms.

Please keep in mind that this guide cannot replace a face-to-face evaluation with your own health care provider. It is meant to provide helpful information while you are awaiting evaluation or to supplement what you may have already learned after evaluation with your doctor.

In this guide, you'll be asked a series of questions about some of the most common conditions that may explain your symptoms. This guide will cover the most common reasons for problems with smell and taste; however, it won't cover every cause.

So, if none of the conditions covered in this guide seem to apply to you, keep in mind that sometimes no cause is found. Or, you may have a rarer cause of a smell or taste problem that is not covered here.

If your loss of smell is new, it could be an early symptom of COVID-19. Contact your doctor today, and then return to start our guide.

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The first questions are aimed at the possibility of a serious or dangerous cause of your symptoms.

Did your smell or taste problems begin after a head injury?

Or, did your symptoms start along with any of the following?

- A severe headache

- Weakness on one side of the body

- Slurred speech

- Inability to walk

Yes, I had a head injury and/or have those other symptoms.

No, I've had no head injury and don't have those symptoms.