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DeQuervain’s tenosynovitis (see our regional MSK disorders webpage) is a tendonitis found at the base of the thumb extending up the lateral aspect of the forearm. There are many available treatment options, including splinting, anti-inflammatories, and perhaps most important, physiotherapy. A cortisone injection is also an option for some patients. If possible, it is important to identify the underlying cause to prevent it from returning.

Molly from Portland asks: In regards to Lupus, I was interested in learning about the connection between how high an ANA titer was and disease activity and/or severity. Is there any way someone with a low titre could have more activity and/or more severe signs and symptoms than someone with a higher titre?

In 2013, most patients who have systemic lupus must be ANA positive. Conversely, a negative ANA essentially rules out a diagnosis of systemic lupus. However, an ANA test is not typically used to follow disease activity. Therefore, a higher titre does not correlate well with disease activity. Other investigations, including markers of inflammation, complement levels, and other antibodies correlate better, but even then, it is not a perfect tool.

Julia from Edmonton asks: What tests are done to confirm RA? Is it possible to have normal blood labs and still have this disease?

There is no test that confirms a diagnosis of rheumatoid arthritis. Your story and an appropriate physical exam by your rheumatologist is the best way to make a diagnosis. To answer your question, it is very possible and common to have completely normal blood tests and still have rheumatoid arthritis.

Carolina from Calgary asks: My husband has AS and may be starting a TNF blocker. We were told once he starts it, he will be on it for life, even if he goes into complete remission because the worst thing to do with biologics is to start and stop them since it may increase immunity to it. So, if after a while he is free of symptoms, can he to try to wean off the med or does he have to take it for the rest of his life?

Assuming a good response to a biologic for ankylosing spondylitis or rheumatoid arthritis, one can always try to see if the disease will remain under control off medication, be it a biologic or traditional DMARD. There is a risk of the disease flaring of course, and there is a risk of not having as a good a response to the same medications a second time. However, many patients do this and most do not have problems restarting their medications again.

Joanne from Edmonton asks: I have had 6 episodes of iritis in the last 3 years. Based on the fact that I have had iritis my doctor has done blood work and said one level is slightly elevated. I am wondering if I should be referred to a rheumatologist for further investigation.

Iritis is an inflammatory disease of the iris, the coloured ring around your pupil. Iritis can occur for many different reasons, but can be associated with some rheumatic diseases, most commonly ankylosing spondylitis. It is not uncommon for an eye specialist to refer a patient with uveitis to a rheumatologist for further investigation when another underlying cause for iritis (also known as uveitis) cannot be found.

Betty-Lou from Edmonton asks: I have bursitis of my hip. What should I do?

Trochanteric bursitis is an inflammation of the bursa on the lateral (outside) aspect of the hip. It can hurt more with walking or lying on the affected side. Treatment options may include physiotherapy (see our Regional MSK Disorders page for some basic ones to start), anti-inflammatory if appropriate, and sometimes a cortisone injection into the bursa.

Tiger from Alberta asks: Is an MRI ever used to help diagnose rheumatic disease?

MRI is a sophisticated imaging technology which can look at bone and soft tissue in the body. In rheumatology, an MRI is most often used to help detect signs of inflammation. However, this is not commonly done as inflammation can usually be detected on physical examination with your rheumatologist.

Carmen from Edmonton asks: Can I safely take Tylenol for pain while receiving Methotrexate injections?

Over the counter pain relievers such as acetominophen (Tylenol), ibuprofen (Advil, Motrin) and naproxen (Aleve) are all generally safe to take with methotrexate.

Chris from Sherwood Park asks: I am taking methotrexate injections. folic acid and Humira for my RA. I seem to be getting many more canker sores lately. Is there anything else I can do besides taking the folic acid to prevent them?

Mouth sores can be a side effect from methotrexate and one you should discuss with your rheumatologist to determine the best way at treating them. Options include increasing the dose of folic acid, decreasing the methotrexate, or replacing folic acid with folinic acid. The choice is unique to each patient’s situation and should be discussed with your doctor.

Michelle from Sunny Island Beach asks: I have RA and Lupus and have been taking Methotrexate and Plaquenil in combination with rituximab. My insurance will no longer cover Rituxan but it will cover Humira or Enbrel. Is it possible to replace rituximab with a TNF blocker? My doctor told me I can’t “step down” from rituximab to another medication.

For rheumatoid arthritis, there is no clear evidence to suggest any biologic when used under optimal conditions is better than another. A patient would never be stepping down between different biologics, just switching. However, patients with lupus do need to be cautious with TNF blockers as they can exacerbate their disease. Rituximab is considered safer for lupus patients.