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Anne from Calgary asks: I have a friend with fibromyalgia. She has said many times that fibromyalgia shortens life expectancy, and she is very frightened about this. I was glad to see that Alberta Rheumatology’s fibromyalgia webpage says that fibromyalgia is not associated with a shorter life span. Could you please cite a source for this, such as a journal article, so that I can show it to my friend? She would find it comforting.

You are correct to say there is no data to suggest fibromyalgia affects life span. A recent 2011 paper by Dr. Fred Wolfe, published in Arthritis Care and Research, showed this again.

Dallas from Edmonton asks: My fiancée and I are getting married in less than a month and we have starting talking about having a family. I’m currently taking Methotrexate injections once a week. We are worried that the methotrexate could increase the chance of birth defects. Has there been any studies done regarding the effects of methotrexate in men when trying to have a baby?

Certainly females should not get pregnant while on methotrexate, with recommendations suggesting that women should stop methotrexate at least 3 months before trying to become pregnant. The data for men is less clear. There are rheumatologists who recommend the same for men, avoidance of methotrexate for at least 3 months before trying to conceive. There are suggestions that methotrexate could affect sperm, however, no study has clearly shown any harmful effects.

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.

Michele from Camrose asks: I was diagnosed with mixed connective tissue disease and am taking plaquenil. Should I be getting a flu shot and also I am in need of my second MMR immunization. Is it safe to proceed?

As a general rule, most vaccines are safe for those with a rheumatic disease and on treatment. In fact, patients are encouraged to receive an annual influenza vaccination.

Caution is required for live vaccines, such as MMR (measles, mumps and rubella), depending on the medication you are taking. Visit our vaccination page to find out more, but always discuss the details of your particular situation with your physician.

Jen from Edmonton asks: My methotrexate vial says “for intramuscular, intravenous, and intra-arterial use only”, but I am supposed to inject it subcutaneously. Should I be concerned?

Methotrexate use for rheumatic diseases, including rheumatoid arthritis, can be given as a tablet or injection. For those receiving methotrexate by injection, self-injection is done subcutaneously – under the skin. An intramuscular injection can also be done, although usually cannot be self-administered. Methotrexate should not be put directly in a vein or artery for rheumatic diseases. To learn more about how to do methotrexate self injections, visit our video here.

Shawna from Drumheller asks: My Father has been diagnosed with Crest Syndrome. I have gone to my family physician because of this family history and have found through some basic testing that I am ANA+. They have tested for lupus but nothing come back. Is this something that I should have further investigated or should I not be concerned?

For everyone else, CREST syndrome is now more commonly referred to limited scleroderma, or systemic sclerosis. CREST stands for Calcinosis, Raynaud’s, Esophageal Dysmotility, Sclerodactyly and Telangiectasias, which are common but not complete manifestations of scleroderma.

An ANA test is a non-specific test on its own. Approximately 10% of the population is ANA+, and over 95% of them will never have an autoimmune disease. The most important thing to do, whether or not an individual is ANA positive, is to always monitor for manifestations of illness and to follow up with your physician at that time. For more on lupus, click here.

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.

Donna from Calgary asks: I have been diagnosed with osteoarthritis, and experience a lot of pain in my shoulders , lower back , knees and hands. My question is what medications can I take that won’t harm my kidney? I’ve had a lot of cortisone shots but was told I may not be able to have that much longer. I just not sure what to do at this time.

The focus for management of osteoarthritis is around improving function and reducing pain. Of course, we want to reduce pain in the safest way possible, and the safest way is different for different people. For most people, acetaminophen (Tylenol) is one of the safest pain relievers. While most individuals will use acetaminophen when the pain is worst, for those with chronic pain, acetaminophen is more effective when used on a regular basis to prevent pain flares, never using more than recommended on the bottle. Anti-inflammatories (NSAIDs) arguably may be more effective, but do have other side effect concerns, and should be avoided for those with kidney problems. Topical anti-inflammatories are available which are likely safe even for those with kidney problems. Cortisone injections are a safe option as well and certainly there is no limit how long you can have cortisone injections, as long as they are effective.

Finally, often forgotten but perhaps most important is the role for physical and occupational therapy. Maintaining range of motion and muscle strength is an important part of management of osteoarthritis, and by its very nature is safe.

Linden from Montreal asks: My wife suffers from rheumatoid arthritis. She normally takes etanercept injections to mitigate the symptoms of her arthritis. She is now breastfeeding and has stopped taking the injections for some time. Her inflammation and pain are getting worse, and we are wondering if it is safe to use etanercept during breastfeeding.

There is limited data about the safety of entanercept or any of the other TNF antagonists during pregnancy and breastfeeding. From the available data, there is no clear indication that TNF antagonists are problematic in pregnancy and breastfeeding. As rheumatoid arthritis goes into remission for many women, and with some uncertainty of safety still present, most women will stop TNF blockers when they know they are pregnant. That said, there are many women who have had successful pregnancies while using TNF antagonists.

For breastfeeding, officially, it is not recommended by the pharmaceutical manufacturers of these medications. However, there is no data to suggest it is harmful to the baby. There is a very small amount of TNF antagonist that is excreted in mother’s milk; it is thought, though, that the medication is broken down in the baby’s gut and therefore is likely not harmful. Ultimately, each individual must balance this small unknown risk and the functional abilities of the mother to care for their newborn if they have active inflammatory arthritis.

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.