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While Ankylosing Spondylitis usually affects the back, it can affect other joints as well. Larger joint involvement is more common than smaller joints such as the hands or feet. Tendon involvement, particularly where the tendon attaches to the bone, can be seen.

Jackie from Albuquerque asks: I am worried I may have been exposed to HIV. I also have rheumatoid arthritis and am on a biologic. I have tested negative for HIV, but could my biologic be interfering with the results?

There are a number of different tests for HIV. Some could be impacted by a biologic in early infection, although data is not clear. To be sure, it is best to discuss this with your physician and rheumatologist. Conversely, it is important to be aware that being on a biologic can increase your risk of a more active HIV infection.

Fanchi from Edmonton asks: I may have rheumatoid arthritis but have not been diagnosed yet. What can I do, if my symptom continues, before I meet a rheumatologist?
If I have to use expensive biologic DMARD, is there any way to find some insurance plans that can cover most of the cost?

For patients with rheumatoid arthritis, the use of disease modifying medications is key to control symptoms AND more importantly, the underlying disease. For a variety of reasons, it can take time for them to work, but there are other options to control symptoms, such as pain, while waiting. While best to discuss with your own physician, anti-inflammatories (NSAIDs) are a good first choice for many patients, such as ibuprofen or naproxen. Sometimes, cortisone injections into particularly painful joints, or even a short course of prednisone by mouth, could be used. Physical therapy also has an important role to protect joints in this early phase of rheumatoid arthritis.

While expensive, rheumatologists in Alberta are usually able to work with patients to find a way to fund biologic medications. It would be unusual to not provide needed treatment because of funding issues for most patients with rheumatic diseases in Alberta.

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.