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Answers: Page 10 of 12
Q:

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.

Q:

Michelle from Edmonton asks: I have recently been diagnosed with osteoarthritis.  What sort of exercise can I do and what should I avoid?

While osteoarthritis has classically been described as a wear and tear arthritis, it is now understood to be much more complicated than that.  In general, activity is good for joints and maintaining joint mobility can lead to better outcomes.  Ultimately, physical therapists are the best resource to put an appropriate and safe plan in place for rehabilitating a joint, as the plan must be individualized for each person.  In general, there is no exercise that you should not do, but you should always listen to your body; if it hurts, stop.

Q:

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.

Q:

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.

Q:

Lorna from Sherwood Park asks: How do I see a rheumatologist?

In Alberta, a rheumatologist sees patients when consulted by another physician.  Most commonly, a family physician will feel their patient would benefit from seeing a rheumatologist, particularly if they feel their patient may have inflammatory arthritis or a related rheumatic disease.

Q:

Elizabeth from Edmonton asks: I was prescribed Fosamax (alendronate) last year. Is this a medication that I take for the rest of my days? It was prescribed to help my thinning bones. Is there a better drug on the market in 2015?

Alendronate is in a class of medications called bisphosphonates, which are most commonly used in the management of osteoporosis.  There are other options on the market in this same class, but that is not to say one is better than the other.  Usually, when one starts treatment for osteoporosis, it is for a longer period of time, at least a few years.  However, the optimal period of  time to remain on treatment remains unclear.  There are other medications for osteoporosis available too, but none that are clearly better.  Speak with your rheumatologist or family doctor to find out if another option is right for you.

Q:

Gary from Alberta asks: I have very frequent lower back pain.  What can I do to stop the pain that ends up as acute muscle spasms and immobilizes me??

Mechanical back pain is a very common problem, affecting most adults at some point in their lives.  Unfortunately, for some, this pain can become chronic and difficult to manage.  Aside from medications, a proper rehabilitation program is essential in the treatment of back pain.  Physiotherapy – where a person learns exercises for range of motion, stretching, and strengthening of back muscles – can have real impact over time.  It is a pro-active approach, hopefully lessening or eliminating flares of pain in the future.  It only works if patients are persistent with it, putting the time in at home on a regular basis with the exercises they were taught by their rehab specialist.

Q:

Lynne from Canada asks: Where can I find more information on Sjogren’s syndrome and how is it related to what a rheumatologist does? This information should be included on this site somewhere…just a suggestion.

You’re absolutely right.  We continue to work on improving our content.  In the meantime, Sjogren’s syndrome is an autoimmune inflammatory condition which most commonly causes a dry mouth and dry eyes, but some people with Sjogren’s syndrome will experience a variety of other symptoms too.  Arthritis, fatigue, generalized pain, change in strength or sensation, as well as effects on the heart, lungs, and kidney are a few of the other manifestations of Sjogren’s syndrome.  Sjogren’s syndrome is one of the many conditions that a rheumatologists has expertise in and helps these patients manage their symptoms.   Visit our Links page for more information, or the Sjogren’s Syndrome Foundation website at www.sjogrens.org.

Q:

Gwen from Edmonton asks:  I was diagnosed with fibromyalgia rheumatica 4 years ago….took prednisone ….tapered very slowly off this summer…….now all the symptoms are back…..how long does this disease last?

It is common to confuse fibromyalgia and polymyalgia rheumatica (PMR) – the first is a condition associated with chronic pain and can be treated with a number of non-pharmacologic options, while PMR requires low dose prednisone for approximately one year.  In most cases of PMR, a slow titrating course of prednisone is effective, although there are times when symptoms return.  For these cases, retreatment with prednisone, or the addition of steroid sparing medications, is considered.  Equally important is to review your symptoms with your physician to ensure the correct diagnosis, or change in diagnosis.

Q:

Jack from Edmonton asks: I have been told I have skin lupus, but is there such a problem?

While our website focusses on systemic lupus, there are other forms of lupus, particularly those that affect only the skin.  Dermatologists usually treat these forms of lupus, not rheumatologists, with topical medications or medications like chloroquine or hydroxychloroquine.  It is not uncommon that a rheumatologist will see a patient with “skin only lupus” to make sure they do not have any other manifestations that suggest the skin is in fact only one component of systemic lupus.



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