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Answers: Page 3 of 7

Dee from Edmonton asks: Do I need to be in a flare to be tested for RF or anti-CCP antibody?

Rheumatoid Factor (RF), and Anti-cyclic Citrullinated Peptide Antibodies (anti-CCP) are tests which are often performed in the work up of rheumatoid arthritis.  A patient does not need to be in flare to have these tests done.  However, these tests do not definitively diagnose rheumatoid arthritis.  Many patients with rheumatoid arthritis can be negative for both of these tests.  Many patients with a positive rheumatoid factor may never have rheumatoid arthritis, although this is less common for anti-CCP.  The best way to diagnose rheumatoid arthritis is by having your physician or rheumatologist listen to your symptoms and perform an appropriate physical examination.


Rod from Rocky Mountain House asks: I have had hip pain for some time and had an MRI recently to look for a cause.  However, the pain was not as bad that day.  Does that mean the test was a waste?

As a general rule, it is unlikely that the underlying cause of the pain would have resolved and not be seen on an MRI even if the pain was less at that time.


Faith from Calgary asks: Can osteoarthritis in the back hurt?  Do rheumatologists treat osteoarthritis?

Osteoarthritis, regardless of its location, certainly can cause pain.  There is no cure for osteoarthritis, but treatment options do exist which revolve around pain control and improved function.  For osteoarthritis of the back, we always need to be careful to ensure it is truly degenerative arthritis causing the pain, as x-rays of the back which show osteoarthritis do not necessarily mean that’s the cause of back pain.  One of the best treatment options for back pain is physiotherapy, with an emphasis on exercises related to strengthening, stretching, range of motion and core abdominal muscles.  While those with back pain need to do these exercises regularly to have benefit, they can improve pain significantly, and can all be done from home without needing regular physiotherapy appointments.

Rheumatologists do see patients at times with osteoarthritis, often for one appointment for a full assessment and provide advice to the patient and the referring physician.


Wendy from the UK asks: Does the treatment of Polymyalgia Rheumatica with steroids prevent Giant Cell Arteritis?

Polymyalgia rheumatica (PMR) and giant cell arteritis, otherwise known as GCA or temporal arteritis, are distinct condition that may present at the same time.  Many patients with GCA also will present with PMR, while a smaller proportion of patients with PMR present with GCA.  While the treatment for both starts the same – glucocorticoids – the doses are very different.  PMR is treated with low dose prednisone, while GCA initially requires high dose prednisone.  That said, once on prednisone, the risk of developing GCA, and particularly loss of vision from GCA, drops significantly.


DeAnna from Edmonton asks: Do I have to be in a pain flare to be tested for rheumatoid arthritis?

Rheumatoid arthritis is diagnosed by an arthritis specialist, usually a rheumatologist, after speaking to a patient, performing a physical examination, and reviewing any pertinent investigations.  It is possible for all tests to be normal and still have rheumatoid arthritis.  For a physician to diagnose rheumatoid arthritis, it does not have to be at its worst, or in a flare.


Cathy from the Unites States asks: I am losing my hair from methotrexate.  Is there anything I can do?

While not common, hair loss is a known side effect from methotrexate.  Usually, complete hair loss is not seen at the doses used to treat inflammatory joint and skin conditions, although it certainly can be concerning for individual patients.  Options to reduce this side effect include ensuring you are taking appropriate doses of folic acid, even up to 10 mg per day.  A related medication, called folinic acid, can sometimes be helpful, but should be discussed with your physician.  A dose reduction in methotrexate can also be helpful.  If none of these are effective, have a discussion with your physician to review alternate treatment options.


Caroline from Scotland asks: Does Ankylosing Spondylitis affect joints besides the back?

While Ankylosing Spondylitis usually affects the back, it can affect other joints as well.  Larger joint involvement is more common than smaller joints such as the hands or feet.  Tendon involvement, particularly where the tendon attaches to the bone, can be seen.


Jackie from Albuquerque asks: I am worried I may have been exposed to HIV.  I also have rheumatoid arthritis and am on a biologic.  I have tested negative for HIV, but could my biologic be interfering with the results?

There are a number of different tests for HIV.  Some could be impacted by a biologic in early infection, although data is not clear.  To be sure, it is best to discuss this with your physician and rheumatologist.  Conversely, it is important to be aware that being on a biologic can increase your risk of a more active HIV infection.


Fanchi from Edmonton asks: I may have rheumatoid arthritis but have not been diagnosed yet.  What can I do, if my symptom continues, before I meet a rheumatologist?
If I have to use expensive biologic DMARD, is there any way to find some insurance plans that can cover most of the cost?

For patients with rheumatoid arthritis, the use of disease modifying medications is key to control symptoms AND more importantly, the underlying disease.  For a variety of reasons, it can take time for them to work, but there are other options to control symptoms, such as pain, while waiting.  While best to discuss with your own physician, anti-inflammatories (NSAIDs) are a good first choice for many patients, such as ibuprofen or naproxen.  Sometimes, cortisone injections into particularly painful joints, or even a short course of prednisone by mouth, could be used.  Physical therapy also has an important role to protect joints in this early phase of rheumatoid arthritis.

While expensive, rheumatologists in Alberta are usually able to work with patients to find a way to fund biologic medications.  It would be unusual to not provide needed treatment because of funding issues for most patients with rheumatic diseases in Alberta.


Anne from Calgary asks: I have a friend with fibromyalgia. She has said many times that fibromyalgia shortens life expectancy, and she is very frightened about this. I was glad to see that Alberta Rheumatology’s fibromyalgia webpage says that fibromyalgia is not associated with a shorter life span. Could you please cite a source for this, such as a journal article, so that I can show it to my friend? She would find it comforting.

You are correct to say there is no data to suggest fibromyalgia affects life span.  A recent 2011 paper by Dr. Fred Wolfe, published in Arthritis Care and Research, showed this again.

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