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Answers: Page 6 of 13
Lisa from St. Albert asks: My doctor thinks I might have ankylosing spondylitis. Although I can control the pain most of the time with exercise and mild anti-inflammatories, is there any additional benefit in getting a definitive diagnosis and in seeing a rheumatologist?
For both mechanical and inflammatory back pain, exercise and anti-inflammatories remain first line options for treatment. A definitive diagnosis of ankylosing spondylitis may be helpful for individuals to have access to other treatment options if first line management is not effective. A rheumatologist may also be able to better monitor you and suggest treatment for other manifestations of ankylosing spondylitis, such bowel, eye, skin involvement.
Cindy from Calgary asks: I tested positive for the ANA blood test. How can I get a confirmed diagnosis and treatment right away, if confirmed?
An ANA test is a non-specific test which may be associated with autoimmune diseases. In rheumatology, that means systemic lupus or other connective tissues diseases. An ANA test does not confirm a diagnosis. In fact, 10% of the general population has a positive ANA test and the majority – more than 95% of them – do not have and will never have lupus. To diagnose lupus or another connective tissue disease, it requires you and your doctor or rheumatologist to review your symptoms and overall health, complete a physical exam, and then pursue investigations based on that information.
Bazgha from Fort McMurray asks: My wife has rheumatoid arthritis; she has pain in her hand joints. What kind of exercise would you recommend to ease the pain and stop the condition from getting worse.
Exercise is good for the body and similarly, good for joints. Keeping muscles strong around joints may help reduce pain and will help maintain function. Weaker muscles may lead to more pain and less ability to do day to day activities. Of course, everyone should always listen to their bodies – whether or not they have arthritis – so as not to over do it. If it is starting to hurt too much, take a break.
It is recommended that for biologic DMARDs, patients delay the medication during a severe illness, particularly if they have a fever, or require antibiotics.
George from Chicago asks: My mother has rheumatoid arthritis. She is afraid to take medications due to all their risks and the need for bloodwork. I searched RA without medication showing that it can cause a shorter life span, including heart failure, and lung damage.. is this true?
Studies show that poorly controlled rheumatoid arthritis may shorten one’s life span by about 10 years, with cardiovascular disease risk being one of the biggest risks. Poorly controlled RA can affect many other organs outside of the joints, as it truly is a systemic disease. Our current treatment options are generally very good at treating rheumatoid arthritis, limiting the risk of organ involvement and we believe improving life span. Unfortunately, no medication is without its risks and treatment options for rheumatoid arthritis are no different. For most people, the benefit of taking the medication outweighs the risks. Every person with rheumatoid arthritis deserves to have a conversation with their rheumatologist outlining all the risks of a given medication AND their benefit, as well the benefits and risks of not taking medication, so a decision can be made based on all the information available and that is right for you.
Shannon from Strome asks: Would you recommend the practice of yoga for inflammatory arthritis patients? Would you share benefits of a regular yoga practice and any cautions or concerns you may have?
While there are studies looking at the potential benefits of yoga for individuals with inflammatory arthritis, they are limited. That said, the results that have been published appear encouraging, with improvement in pain and quality of life. The risks of yoga, as would be the case for most forms of exercise, are small. It is generally considered quite safe. Just like someone who does not have arthritis, if something hurts, you listen to your body and stop. However, yoga should not make the arthritis itself worse and has many potential benefits to those who participate.
Tina from St. Albert asks: I have arthritis in my knees. It is so bad and the meds I tried don’t help… from advil to Voltaren to ketoprofin and Diclofenac Sodium. Is there a shot of something that would help? It’s hard to walk and swim and sleep etc. I’m trying to lose weight and exercise, but it hurts too much to keep up my walking regiment. Thanks.
The goal for treatment of osteoarthritis, be it in the knees or elsewhere, is to improve pain and function. There are a number of different strategies, many of which can be used at the same time. Pain relievers, starting with regularly scheduled acetaminophen, or NSAIDs as described above, work for some people. For the knees in particular, braces can help. Weight loss, exercise, and maintaining muscle strength around the knees can also be an important part of management. Injections into the knees, often with cortisone but also hyaluronic acid, can also help some people. A walking aid, such as a cane or walker, may also help. If none of the above are helpful alone or in combination, speaking to an orthopedic surgeon about the benefits and risks of a knee replacement may be an appropriate next step.
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.
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.
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.