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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.

Lynne from Edmonton asks: Could you please discuss the link between RA and Fibromyalgia? I have been diagnosed with RA but at times my whole body hurts…just wondering if that might be what I have..

Up to one-third of patients with rheumatoid arthritis may also develop fibromyalgia. As the rheumatoid arthritis gets under better control, your sleep will improve as will your ability to be more active; this should lead to improvement in the more diffuse pain from the fibromyalgia too.