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Kim from the United States asks: Many years ago, I was diagnosed with polymyalgia rheumatica when I could not turn over in bed and my ESR was elevated. I was treated for many years with what ended up being 5 mg of prednisone per day. Several attempts to quit taking it failed and my rheumatologist said that some patients have to take it for years. I moved two years ago and my new rheumatologist made me stop taking prednisone because I no longer had an elevated ESR. This has really affected my health and I live in pain without it. I have been off prednisone for about six months and my life quality is greatly reduced. I am otherwise pretty healthy with no heart disease or diabetes. I don’t understand why this is such a big deal to my doctor. Do you have any advice for me?
In general, the risks of prednisone are significant, as you can read here. Those risks increase with higher dose of prednisone, but also for how long someone takes prednisone. Of course, the balance is the quality of life prednisone, or any treatment, can provide. While PMR classically presents with proximal muscle pain around the hips and shoulders associated with an elevated ESR, this does not need to be the case. In situations like these, which apply to PMR but many rheumatic diseases, speaking to your rheumatologist so you are both on the same page is worthwhile. Does your rheumatologist believe there is a different cause for pain now and if so, discuss a new treatment approach that will be effective for this pain? If it is still PMR, can your rheumatologist discuss other options that are available that may be effective at treating PMR but without the need for prednisone? These can be common situations and often the opportunity for clear communication helps so everyone is on the same page.
Julie from Calgary asks: Does a negative test rule out ankylosing spondylitis?
As of 2017, there are no definitive blood tests which can diagnose or rule out ankylosing spondylitis. HLA B27 is a genetic marker which is often found in patients with AS, but it is not required to make a diagnosis. Similarly, inflammatory markers in the blood may be elevated in AS, but may also be normal. To make a diagnosis of ankylosing spondylitis, or to rule it out, a patient should review their story with their physician or rheumatologist. The rheumatologist often will obtain further imaging, including x-rays or an MRI of the lower spine, to help ascertain a diagnosis.
Steve from Charleston asks: Is an elevated CK a sign of inflammation?
CK, or Creatine Kinase, is an enzyme released by muscle in the body. When the muscle is being damaged, the amount of CK released increases. Some people always have a higher than normal CK, which may be fine for them. Some people have their CK rise after vigorous exercise, which for most individuals, is not a significant concern. CK can increase in diseases which cause inflammation in the muscle, but it is not a specific sign for inflammation. Rather, it only suggests something is happening the muscle, but not specifically what.
Karen from Calgary asks: Is it possible to have both osteoarthritis and rheumatoid arthritis?
Both osteoarthritis and rheumatoid arthritis can happen in the same person. Unfortunately, if you have one, it still is possible to have the other as well. It is important for you and your physician to be able to differentiate which joints are affected by which condition. The best way to do this is to describe to your physician which joints are involved and how they feel, while your physician will complete an appropriate physical exam. Further investigations such as blood tests or imaging can be helpful, they are often far from definitive in making a diagnosis on their own.
Making the right diagnosis ensures the right management choices are being made, as treatment for OA and RA are different. To learn more about OA and RA and treatment options, please click on the highlighted links above.
Many people ask from across Alberta: How can I arrange an appointment with a rheumatologist?
Unfortunately, an appointment cannot be arranged through this website. As noted in the instructions above, “Ask the Rheumatologist” is not equipped to arrange appointments or answer questions that are specific to one person. In Alberta, to see a rheumatologist, and most specialists, you need a physician, usually your family doctor, to write a letter to the rheumatologist requesting an appointment. If your physician will not make the referral, it’s valuable to have a conversation with them to try to understand why that is, and for you to explain why you think a referral should take place; this hopefully ensures you and your health care provider are on the same page.
Robert from Edmonton asks: Is there a phone number to speak to someone about medications and immunizations for rheumatoid arthritis?
There is no “hotline” available, but certainly there are resources. This website, under the Medications tab, does list immunization/vaccination information for our patients. Your rheumatologist also is available to take phone calls from you. For general education needs, in Edmonton, we offer a 3 day Rheumatoid Arthritis Education program. Speak to your rheumatologist if you are interested and they can enroll you in this excellent program.
James from Sherwood Park asks: Are there any support groups in the Edmonton-area for the spouses of those managing chronic pain? My wife has RA and I think it would be beneficial to hear from other supporting partners in how they manage with the daily challenges/opportunities when living with someone in chronic pain?
There are no specific programs that are associated with rheumatology. However, it is very common for spouses to attend support groups with their partner and connect with others on the effect rheumatoid arthritis has had on the patient and their family. Speak to your rheumatologist about a referral to the Rheumatoid Arthritis Education Program, an excellent course which covers all aspects of RA, including how to provide support.
Travis from Calgary asks: Do rheumatologists treat Raynaud’s phenomenon?
Raynaud’s is a condition where upon exposure to cold, the peripheral parts of the body – fingers and toes, but sometimes nose or ears – can become painful and change colours from white to blue to red. It is certainly a condition that rheumatologists may see. Raynaud’s can occur in individuals “just because”, often starting as a young adult. It can also happen in association with other rheumatic diseases, including rheumatoid arthritis, lupus, and scleroderma. A rheumatologist can assess a person for Raynaud’s, make suggestions to help, and also ensure the person does not have any underlying rheumatic disease too.
Marieanne from Sarnia asks: I was recently diagnosed with rheumatoid arthritis. I was started on a tapering dose of Prednisone, methotrexate, and hydroxychloroquine. It has been nearly 3 months and I am still noticing increasing pain and worsening symptoms if I lower my prednisone dose. Is this normal?
The goal in the treatment of rheumatoid arthritis is to eliminate joint pain, stiffness and swelling while improving function and preventing joint damage. DMARDs, including methotrexate and hydroxychloroquine, are the class of medications which are used to achieve this goal. However, they do not always work as well as we want. It is important to work with your rheumatologist to find the right combination of DMARDs that work for you. Fortunately, there are many options available, and many patients are able to find success with the right combination. Until that combination is found, treatment also needs to focus on ensuring best control of your symptoms. That may include pain relievers, anti-inflammatories, or glucocorticoids such as Prednisone.
The process to find the right treatment combination can be slow in some patients. That can be frustrating as it sometimes can feel like your health care team will never find the right treatments. A positive attitude, education around your disease, and working with your rheumatologist and health care team members will help you achieve your goals.
Robert from the United States asks: Is leflunomide a steroid? Can leflunomide and prednisone be used together?
Prednisone is a steroid, while leflunomide (Arava) is a disease modifying anti-rheumatic drug (DMARD) used to treat rheumatoid arthritis. Another term for DMARDs is a steroid sparing agent, meaning they aim to achieve the same goals as steroids, but ideally with less side effects. Prednisone works much faster than leflunomide, days versus weeks. Because of that, it is not unusual for a patient to be started on both: Prednisone to help control symptoms short term and then stopped once leflunomide has begun to take effect. This same idea would apply for most DMARDs.