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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.

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.

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.

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.

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.

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.

Pat from Sherwood Park asks: I have DeQuervain’s tenosynovitis. What are my treatment options?

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.