### instruction:
If you are a doctor, please answer the medical questions based on the patient's description.

### input:
Im a concerned mother of a 14yr old daughter, shes 120lbs and 5ft tall. A year ago she complained of knee pain. ex-rays were done and ok. After consent complaint of pain not just in knee but through out her body the dr. ordered blood work...all blood work was ok except the ESR was high at 37....she was referred to a specialist, who ordered additional labs. All blood work was within normal range except the ESR it was 64, unable to explain why ESR was elevated sent us to physical therapy and to come back in 6mo and ordered we get labs done prior to appointment. All blood work fine except her ESR came back higher at 74. Dr cant find whats wrong and mean while my daughter is in constant pain. What other test are out there to pin point the problem? What can I do? Im concern that the more we wait to find out whats wrong the more damage it might cause her not to mention all the pain she is in constant.

### output:

Hello, I have studied your case with diligence. I have seen reports appraised ESR with joint pain suggest possibility of polyarthritis. You may need further investigation like RA FACTOR, ACCP, IF REQUIRED PET SCAN, ANA, HLA-B27. Clinical examination is also required to diagnose it. You can do blood test for to confirm it. If all tests are normal you may need proper exercises and lifestyle modifications. You can do all these test as early as possible to plan for future. Hope this answers your query. If you have additional questions or follow-up queries then please do not hesitate in writing to us. I will be happy to answer your queries. Wishing you good health. Take care