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Answers tagged rheumatoid arthritis: Page 4 of 5
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Linda from Canada asks: My rheumatoid arthritis doctor mentioned that I have erosions. Could you please explain this…how serious is it? Is there something one can do for it?

Rheumatoid arthritis causes joint pain, stiffness, swelling, functional impairment, and if not controlled quickly enough, it can cause permanent damage to the joint.  The first sign of permanent damage is an erosion, a small bite out of the bone about the joint.  A small bite of the bone is not something that a person will notice, but if it continues to develop bigger and there are more of them, it can cause significant deformity in the future.  Once an erosion occurs, it cannot be reversed.  However, aggressive treatment to control rheumatoid arthritis can prevent further damage from happening.

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Daniel from Edmonton asks: My friend has psoriatic arthritis. He is in a lot of pain and is getting treatment to help deal with his condition. One thing he would like to do is start a fitness routine to help. I’m looking for advice on how to help plan and work in a fitness routine that could account for his joint pain.

Great question!  We encourage our patients with inflammatory arthritis to stay active despite having arthritis.  We know that maintaining activity and muscle strength is a positive, and can be an important component of treatment and well being.  Further, activity itself should not make the arthritis worse.  That said, every individual is different and we need to ensure an appropriate balance between remaining active and not causing pain.  Physical therapists with expertise in inflammatory arthritis are often involved in consulting and developing activity plans.  Your rheumatologist should be able to recommend an appropriate physical therapist to you.

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Dallas from Alberta asks: I have been on methotrexate for 5 months and started to notice that I am losing my hair.  What should I do?

While not a common occurrence for most people on methotrexate for their arthritis, hair loss certainly is a known side effect.  Certainly this should be discussed with your rheumatologist to determine the best option in any particular case.  For some, increasing folic acid intake may be quite helpful at reversing the hair loss.  For others, lowering methotrexate or considering an alternative may be necessary.  Making the appropriate adjustments with your rheumatologist will ensure the best chance of reducing any side effects while still ensuring your arthritis is, or becomes, under good control.  Keep in mind, even if the hair loss stops, it unfortunately can take months before you notice the improvement.  Hair loss from methotrexate is usually reversible; hair will grow back.

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Deb from Edmonton asks: What causes hip involvement in rheumatoid arthritis?

Rheumatoid arthritis can involve essentially any joint in the body with few exceptions.  This includes both small joints, such as those in the hands and feet, as well as large joints, such as the shoulders, knees, and hips.  Treatment typically is the same regardless of the joints involved.

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Tara from Edmonton asks:  I tested positive for Sjogren’s syndrome and Rheumatoid Arthritis.  Can you please tell me something about them?

Sjogren’s syndrome is an autoimmune disease with its most common symptom being dry eyes and dry mouth.  Read here for more on rheumatoid arthritis, and check out this previous answer for more information.  However, you should know there is no definitive test for rheumatoid arthritis or Sjogren’s syndrome.  There are tests that are associated with these conditions, but they are not definitive.  To make a diagnosis of most rheumatic diseases, including rheumatoid arthritis and Sjogren’s syndrome, an expert in these conditions needs to take a good history and complete a physical examination; then, it is appropriate to look at any investigations and determine how they best fit all together.  There are many patients we see who test “positive” for these blood tests, but don’t have – and may never have – a rheumatic disease.

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John from Prince George asks: I have been diagnosed with rheumatoid arthritis and have developed nodules on my elbows, hands and feet.  Is this normal?

One of the manifestations of rheumatoid arthritis outside the joint is the development of rheumatoid nodules.  These occur in just under 10% of patients with rheumatoid arthritis and is one of the more common skin manifestation of rheumatoid arthritis.  They often occur on pressure surfaces e.g. elbow, but can occur elsewhere as well.  For most individuals, they are asymptomatic and specific treatment is not necessary for them.  Steroid injections or surgical removal is sometimes considered, although control of the inflammatory arthritis often improves the nodules too.  Paradoxically, in some patients treated with methotrexate – the gold standard for rheumatoid arthritis treatment – the nodules can worsen, and stopping methotrexate can lead to improvement.

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Anne from Calgary asks: I have recently been diagnosed with rheumatoid arthritis.  I also have a lung disease.   I was started on hydroxychloroquine, but shouldn’t I be on methotrexate?

With some types of lung disease, rheumatologists may be cautious using certain typical rheumatoid arthritis medications, particularly methotrexate.  One of the rare side effects of methotrexate is to cause lung damage, something in particular to be avoided in an a patient with bad lungs in the first place.  Fortunately, there are many other good options available to treat rheumatoid arthritis which are relatively safer from a lung point of view.  Hydroxychloroquine is one of these options.  In mild cases of rheumatoid arthritis, this may be an excellent option.  For moderate to severe cases, further discussion with a rheumatologist should lead to an optimal treatment plan.

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Elizabeth from Australia asks: I have rheumatoid arthritis and have been on traditional DMARDs.  My rheumatologist is now considering a biologic DMARD, but they are expensive.  In Alberta, how are biologic DMARDs paid for?  What is the wait time to a see a rheumatologist in Alberta?

Biologic DMARDs are very expensive, with most costing approximately $20,000 annually.  Alberta Health does not subsidize this cost directly, but currently, every Albertan is eligible to pay for medication insurance that would reduce out of pocket costs for biologics by about 90%.  For most patients in Alberta, rheumatologists and their team are able to work with patients to find a way to get the medications they need to ensure their health.

Wait times to see a rheumatologist vary in Alberta between Calgary and Edmonton, and even among rheumatologists.  However, most rheumatologists want to see patients with inflammatory arthritis within 3 months of a referral.

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