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Answers: Page 1 of 14
Kyle from Alberta asks: My doctor did some rheumatology tests. dsDNA came back positive, but then the reflex crithidia test was negative. My ANA is negative. What does this all mean?
These tests are often associated with lupus, but it can get confusing. An ANA test is not diagnostic of lupus; a negative test essentially rules it out, while a positive test often means nothing on its own (1/200 individuals who are positive have lupus). On the other hand, we usually say that dsDNA test is a very good test for lupus. In other words, if you test positive for dsDNA, it usually means you have lupus. Unfortunately, the way the test is run by many labs these days is not as accurate as it was in the past, resulting in false positive results. When a positive result returns, some labs will double check the test with the traditional crithidia method, which is more trustworthy. In someone who is ANA negative and crithidia dsDNA negative, it is reassuring that lupus is an unlikely diagnosis.
Sydney from Leduc asks: I notice some rheumatologists have ultrasound in their office, but not all. Why is this not commonly available for everyone?
Point of care ultrasound (versus ultrasound done at a radiology centre) is becoming more commonly seen in rheumatology offices. It is still not considered standard of practice for rheumatologists, as those rheumatologists who offer ultrasound should have undertaken extra training to ensure they are competent and able to accurately interpret the images. Ultrasound is not necessarily needed for all patients. For most individuals, a good physical exam provides the needed information to make a good plan for managing your arthritis. In some cases, it can be helpful, which is when a rheumatologist who does not do ultrasound themselves will either ask their colleague to perform the test, or have the patient assessed at a radiology centre.
Cherri from Alberta asks: I joined the Patient Advisory Council but haven’t heard anything yet. Is this legit?
We soft launched the Patient Advisory Council about a year ago with a fantastic response so far. We have over 100 individuals who have signed up and are receiving our quarterly newsletter. To sign up, you provide your information here, and then you need to confirm with an email we send you. While right now it’s only a newsletter, we have big plans as we know we need to do a better job, by working together, raising awareness for arthritis care in Alberta, advocating for the best resources and ensuring everyone understands the impact arthritis and rheumatic diseases have. Arthritis is the most common symptomatic chronic disease and we need everyone to understand that.
Julie from Alberta asks: Can I get the measles vaccine if I am taking denosumab for osteoporosis?
Fortunately, denosumab should not impact the ability to receive the measles vaccine safely. However, this is not the case for many other medications used in rheumatology. The Measles vaccine (MMR) is a live attenuated vaccine. While it is safe in most situations and quite effective, we do need to be very careful for those who may be receiving medications that modulate the immune system. This means the majority of disease modifying medications in rheumatology would need to be held for a few months prior to receiving the MMR vaccine safely. Denosumab does not affect the immune system in the same way so should be considered safe in most circumstances. For more information on vaccine safety in rheumatology, please visit our vaccination information webpage. It is always best to check with your rheumatology team to see how to best approach this situation should you need an MMR vaccine, or any other live attenuated vaccine.
Shikha from Edmonton asks: Can a Rheumatologist diagnose whether the symptoms experienced are Chronic Fatigue Syndrome, Auto Immune and or Fibromyalgia?
Yes, this is exactly what rheumatologists do. We listen to your symptoms, to an exam and review any available investigations. Based on this, we can usually determine what is happening and differentiate between these diagnoses.
Linda from Alberta asks: I have been diagnosed with RA and find my joints are making noises like cracking a knuckle. Is this normal or common?
Regardless of the reasons, noises coming from joints are usually not a concern, unless they are also associated with pain. If you are having pain, you can discuss this with your rheumatology team to see if there is something more than needs to be investigated or treated.
Diana from Edmonton asks: What if your appt is 6 months away to be seen by a rheumatologist and neither you or your doctor think you are going to make it that long?
Wait times for rheumatology appointments in Alberta have grown much longer over the last few years. This is never ideal for folks who have joint pain, stiffness or swelling, or symptoms as a result of 100s of different rheumatic diseases. We need over a dozen more rheumatologists in Alberta and/or a new model of care. If your doctor thinks you need care sooner, they can always contact the rheumatologist on call to discuss what is happening and get some advice on what to do in the meantime. Sometimes, this also can result is a sooner appointment. If you are interested to learn more about rheumatology advocacy in Alberta, visit our webpage here to join our patient advisory council.
Unfortunately, there is probably not one best natural supplement for arthritis. There is still limited data to help tell us if a particular natural supplement may help arthritis, which type of arthritis, and what risks there are. That said, we have compiled a list of supplements our patients commonly use with the available research and risks as they exist today. Hopefully this helps.
ESR (erythrocyte sedimentation rate) and more recently, CRP (C-reactive protein), are tests that can detect inflammation in the body. They are not perfect tests. It is possible to have normal results and have active inflammation. It is also possible to have active inflammation which is not related to inflammatory arthritis. For example, an infection will cause these tests to be elevated. These tests typically do not make a diagnosis of inflammatory arthritis on their own, but can help put a picture together of a diagnosis. They can also be used to help monitor how the arthritis is doing, but again, it must be used with other information as well. A normal or elevated test on its own does not mean arthritis is active or not.
Paul from Calgary asks: I have Gout. I take allopurinol and indomethacin; I also take ibuprofen when I have exceeded my daily indomethacin intake. I experience Gout attacks daily. Is there something I can take that would work better?
A few things to consider for gout. 1) It is best not to mix different anti-inflammatories (NSAIDs) at the same time. Once you have maxed your dose on one anti-inflammatory, you are maxed on all of them. It is not a time to switch to another one. 2) If gout is not controlled on allopurinol, it probably means the dose of allopurinol is not right and needs to be adjusted. Watch our recent video for more on this exact topic. 3) If your gout is not controlled on allopurinol and you are having daily attacks, it is possible this is not gout. Reviewing your symptoms with your doctor or rheumatology team may be worthwhile to ensure you are on the right treatment for the right diagnosis.