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Ammar from Alberta asks: Biologics are expensive!  How do I make sure the cost is covered?

Biologics are expensive!  They can range from $10,000 to $25,000 per year.  No one can afford that, which is why having insurance coverage for these medications is important.  Most insurance plans have rules which must be followed to have these medications covered.  Most of these rules are reasonable.  For instance, for rheumatology problems, biologics must be prescribed by a rheumatologist.  You must have a disease that we know is treatable by a biologic.  You must have tried other medications first which we know may work as well (e.g. methotrexate) before trying a biologic.  And finally, we must show that the condition has improved on a biologic.  Working with your rheumatologist, there is nearly always a solution to finding funding for biologics.  If you are having troubles, make sure your rheumatologist knows.


Brenda from Edmonton asks: Can I get the MMR vaccine while on methotrexate?

In most cases, we feel getting MMR on methotrexate is ok, even though it is an attenuated live vaccine.  MMR should not be given to those on biologics however.  For a full list of our vaccination recommendations, please visit our vaccine webpage!


Ahmed from Alberta asks: Where are rheumatologists located in Alberta?  Is there a difference between Calgary and Edmonton?

Most rheumatologists in Alberta are located in Edmonton and Calgary, with the split currently about even between the two sites.  This is also true of pediatric rheumatologists.  Some rheumatologists will do outreach clinics in smaller centres. They have access to very similar resources across the province, so regardless of which rheumatologist you see, you will receive world class care.  To find rheumatologists in Alberta, please visit our webpage listing clinic locations.  To see a rheumatologist, you must have a referral from your own doctor.


Mona from Calgary asks: I don’t see anything about Rinvoq.  My rheumatologist has suggested that one for me.

Rinvoq, otherwise known as Upadacitinib, is part of a newer class of advanced disease modifying medications for inflammatory arthritis called JAK Kinase inhibitors.  To learn more about it and the other JAK Kinase inhibitors that are currently available, visit our webpage here.


Shawna from Edmonton asks: Do you recommend the anti-viral treatments for COVID?

The available treatments for COVID are ever changing.  We try to keep our recommendations up to date on this site here.  As a general statement, most patients under care of a rheumatologist are eligible for anti-viral treatment for acute COVID infections, and most rheumatologists would support this.  If there is ever any doubt, contact your rheumatologist ASAP if you believe you have a COVID infection.  A PCR test is also highly recommended in this case, not just the at home Rapid tests.  Most patients with rheumatic disease remain eligible for PCR testing.


Chelsea from Alberta asks: Can a rheumatologist diagnose Raynaud’s phenomenon and tell if it is primary or secondary?

This is a good reason to see a rheumatologist!  While primary Raynaud’s phenomenon is a relatively benign condition for most people, secondary Raynaud’s could be a result of an underlying rheumatic disease which can be successfully treated.  A rheumatologist is equipped to determine if it is primary or secondary, and make appropriate treatment recommendations in either case.


Usha from Edmonton asks: Are there rheumatology tests for multiple miscarriages?

Miscarriage can be associated with some rheumatic conditions, although most people will have symptoms of them besides miscarriage itself.  The other rheumatic condition which can manifest through miscarriage is something called antiphospholipid antibody syndrome.  It is possible to be tested for these antibodies and if positive, there are recommendations for treatment to lower the risk of subsequent pregnancy loss.


Rhyse from Canada asks: How do I get my doctor to test for Lupus?

Unfortunately, there is no “test” for lupus.  Lupus is best diagnosed by combining a good history (talking with you), a physical exam and correlating those results with blood tests.  A ANA test is a good test to rule out lupus.  If it is negative, most people do not have a lupus.  It is not a good test to diagnose lupus.  While you have to be ANA positive to have lupus, most people who are ANA positive do not have lupus.  If an ANA is positive and you have other symptoms that suggest lupus, then a referral to a rheumatologist is often in order.


Emma from Canada asks: I received my 2 doses of the Moderna vaccine and with the first experienced a 1 week rheumatoid arthritis flare but it was manageable. After the 2nd dose, my RA took a turn for the worst & I have been in the worst flare of my life since (4 months now).  Should I still get the booster?

The best advice for anyone in this situation is to speak with your rheumatologist.  Regardless of the vaccine, a flare lasting more than a few weeks deserves a conversation with your rheumatologist to determine the best course of action going forward to get it under better control.  That said, while there is some evidence that the COVID vaccine may induce flares in a small minority of cases, most times the flare is either a side effect of the vaccine but perceived as a flare (likely what is described after the first shot) or a coincidence of association, rather than causation.  As so many people are getting COVID vaccine, it will happen that some will flare afterwards, but it is likely that many of those flares would have happened anyways.  As a general principle, 3rd (and now 4th) shots for COVID vaccine are encouraged for those with rheumatic diseases.


Hayley from Calgary asks: I have recently gotten sick and need to know if I should continue my methotrexate injections or hold them while I am sick ?

As a general rule, it’s ok to continue traditional DMARDs (examples: methotrexate, plaquenil, sulfasalazine, leflunomide) when sick, particularly anything mild without a fever or needing antibiotics.  For those on biologics, we generally recommend that they are held, particularly if you have a fever or require antibiotics, until you are feeling better.  However, during the COVID19 pandemic, we are often a little more cautious and it would be reasonable to hold any DMARD – traditional or biologic – until you are feeling better.  In most cases for methotrexate, this would mean missing one dose, which wouldn’t impact arthritis control for most individuals.

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