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Rheumatoid arthritis can involve essentially any joint in the body with few exceptions.  This includes both small joints, such as those in the hands and feet, as well as large joints, such as the shoulders, knees, and hips.  Treatment typically is the same regardless of the joints involved.

Among the many potential complications of prednisone use, osteoporosis is one of them.  The risk particularly increases if you require more than 3 months of prednisone.  In this case, calcium and Vitamin D intake are very important.  Recommendations from Calcium intake range from 1000 – 1500 mg per day, and includes calcium from both diet and supplement.  Dietary calcium is likely more ideal.  Current Vitamin D guidelines suggest intake of 800 – 2000 units daily.  Dietary Vitamin D is usually not sufficient and should be supplemented.  For individuals on prednisone, often your physician may speak to you about the addition of a medication in a class called bisphosphonates, which also will help protect the bone.

Sjogren’s syndrome is an autoimmune disease with its most common symptom being dry eyes and dry mouth.  Read here for more on rheumatoid arthritis, and check out this previous answer for more information.  However, you should know there is no definitive test for rheumatoid arthritis or Sjogren’s syndrome.  There are tests that are associated with these conditions, but they are not definitive.  To make a diagnosis of most rheumatic diseases, including rheumatoid arthritis and Sjogren’s syndrome, an expert in these conditions needs to take a good history and complete a physical examination; then, it is appropriate to look at any investigations and determine how they best fit all together.  There are many patients we see who test “positive” for these blood tests, but don’t have – and may never have – a rheumatic disease.

Mixed connective tissue disease (MCTD) is similar and has some overlap to systemic lupus.  By definition, an antibody test called RNP should be positive in MCTD.  However, as in many conditions and tests in rheumatology, a positive test does not necessarily diagnose a disease.  Conversely, a negative test does not always rule out a disease either.  To truly make a diagnosis of MCTD, lupus, rheumatoid arthritis, or many other rheumatic diseases, your doctor/rheumatologist needs to review your personal history with you, complete a physical examination, review the appropriate tests and put all that information together to make an informed diagnosis.

Osteoarthritis to the base of the thumb is a common spot to have osteoarthritis.  Treatment is aimed at managing symptoms and improving function.  Because of this, treatment options that works well for one person may not be as effective for the someone else.  We cover many treatment options on our page for osteoarthritis, but one could consider acetaminophen, NSAIDs, a splint, physiotherapy, topical anti-inflammatories, and/or a cortisone injection, amongst other options.  In terms of natural products, please visit our pages on glucosamine, Sierra Sil, and other available natural health products to review them for yourself.

Vaccines, or immunizations, come in two broad forms.  Most are ok to receive when you have an underlying rheumatic disease and on treatment for it, including methotrexate or even biologics.   For that reason, rheumatologists generally encourage their patients to get the annual flu shot, and to receive the pneumonia vaccine as well.  However, for those vaccines that may have a live component to them, patients may need to be cautious depending on which medication they are on, as you may be at increased risk for developing the condition you are trying to protect yourself from.  While less concerning, these vaccines also may be less effective when on these medications.  If you are able to receive the vaccine before starting them, all the better.  It’s important to discuss the details of any live attenuated vaccine with your rheumatologist to ensure it’s right for you.

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.

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.

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.

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.