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Jody from Edmonton asks: I am worried I have symptoms suggestive of rheumatoid arthritis but all the tests come back negative. What should I do?
Diagnosing rheumatoid arthritis is a clinical diagnosis. While there are blood tests and imaging (including x-rays, ultrasound or MRI) which can be helpful to make the diagnosis, it is possible to make a diagnosis even when all these tests come back normal/negative. Your story and physical exam are critical and should not be ignored. Having a referral to the rheumatology team to listen to your story and determine a diagnosis is a great next step.
Wait times are too long to see a rheumatologist! With a growing Alberta population and recent retirements, there are not enough rheumatologists in the province. We could easily have another 10-15 rheumatologists in Alberta for the number of patients that need to be seen. Unfortunately, there are only about 30 new rheumatologists across the country every year, so it’s not easy to find new rheumatologists. Rheumatologists believe that we can provide better and quicker access to care with an updated model of care, relying on a rheumatology team that includes rheumatologists, nurses, pharmacists, physical therapy, occupational therapy and more. While we continue to advocate, we need a partner in the health system to work with to make this happen. For those who want to help, join the Patient Advisory Council to help have your voice heard.
Yes, rituximab biosimilars are covered by the provincial drug plan in Alberta. In fact, all biologics listed on our website are covered by the provincial plan for inflammatory arthritis.
Gout is a common inflammatory arthritis that is most commonly known for causing acute painful red hot swollen joints that resolve over 5-7 days. While that is typical, that picture can change over time if you continue to have gout flares with poorly controlled uric acid levels in your body. Gout can also cause tophi, lumps of uric acid crystals which can deposit outside of joints. While they are not necessarily painful themselves, they can deposit in awkward locations and cause pain and inconvenience as a result (e.g. elbow, fingers, toes, ears). By treating the underlying cause of gout – lowering uric acid – these tophi can also dissolve and go away. Read more about gout here!
We are fortunate that ALL biosimilars in rheumatology are essentially covered through the provincial drug plan. You can see the options available here for TNF blockers, with more to be available in the coming months. Work with your rheumatologist to find the right medication for you, especially now with so many options available.
Camryn from Edmonton asks: I’m 25 years old and seeking treatment/diagnosis for Ehlers Danlos Syndrome, or hypermobility spectrum disorder, is a Rheumatologist the way to go or should I see a different kind of specialist? It’s hard to find doctors in Canada who are familiar with this disorder, and it’s been disheartening trying to get help. Thanks!
This is a great question. Rheumatologists can be helpful to diagnose and suggest management strategies for hypermobility syndrome. Hypermobility syndromes are conditions which allow for extra range of motion of joints, often due to ligament laxity, but also increase risk for microinjury and pain. Rheumatologists do not provide treat hypermobility themselves, but rather suggest working with a physiotherapist to increase tendon/muscle strength around joints to decrease the extra range of motion. Most rheumatologists in Alberta do not diagnose or treat Ehlers Danlos Syndrome.
Tara from Alberta asks: I am looking for information on both Sjogren’s Syndrome and Rheumatoid Arthritis. Is there more information available on them?
We have information on our website on Sjogren’s and Rheumatoid Arthritis, and videos on specific items on both on our YouTube page. Having the symptoms of both of these conditions is not uncommon. A significant minority of individuals with RA have secondary Sjogren’s syndrome, and of course, Sjogren’s syndrome itself can cause an inflammatory arthritis similar to rheumatoid arthritis. Fortunately, there is also overlap in the treatment options for a number of the symptoms of these conditions. Working with your rheumatologist, significant improvement in symptoms should be achievable.
Tini from Edmonton asks: I am a lupus patient and the pharmacist and my insurance company said that my prescription drug Mycophenolate, which is quite expensive, may not be covered. What should I do?
Mycophenolate is a commonly used medication in the treatment of lupus and other connective tissue diseases. In rheumatology, many medications are used “off label”, meaning they do not have formal Health Canada (or FDA, etc.) approval for a particular use. However, through many studies and years of experience, we know these medications bring significant benefit to the management of rheumatic conditions and are appropriate to use. Despite this, companies have not asked health authorities for more formal approval and without it, insurance companies may not always reimburse the cost. If this is the case, we strongly encourage you to discuss this with your rheumatologist. This is not an unusual situation for your rheumatologist and they often have access to other means of ensuring you can take the best medication for your condition.
Glenda from Fort Saskatchewan asks: Where can I make a donation for Sjogren’s syndrome and its complications?
There are many great organizations that are doing excellent research, including locally in Alberta. Currently there is a growing research program examining connective tissue diseases, including Sjogren’s syndrome, at the University of Alberta. In fact, both the University of Calgary and University of Alberta are well known for the overall quality of research that is produced when it comes to rheumatic conditions.
To consider a donation, you can visit our donation page here or contact the University of Alberta’s Division of Rheumatology division director and administrator, using this link, to make arrangements. Supporting arthritis and rheumatology research will make a significant difference for tens of thousands who are fighting these conditions every day!
Giant Cell Arteritis (GCA) is a form of autoimmune vasculitis (inflammation of blood vessels) that affects large blood vessels in the body, but most commonly arteries in the head area, particularly around the temples. Among other symptoms, it can cause headaches, scalp tenderness, and difficulty chewing your food. Some individuals may also have pain around their shoulders or hips. If not treated, GCA can cause sudden vision problems which in some cases, can be irreversible. This makes quick recognition and treatment of GCA important. GCA is most often first treated with prednisone. For some patients, if they are having difficulty getting off Prednisone, other disease modifying agents may be used. One of the newest treatment options for GCA is tocilizumab (Actemra). While some rheumatologists will use it at the start of treatment with Prednisone, others may wait to see if it is needed depending on how beneficial the Prednisone was. In individual cases, there may be reasons to use it earlier or later.