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In many cases, inflammatory arthritis is a clinical diagnosis, meaning it can be diagnosed by listening to the patient’s story and performing an appropriate physical examination. Rheumatoid arthritis can be associated with a number of positive blood tests, including a rheumatoid factor or anti-CCP-antibody, but a negative test does not exclude the diagnosis. Other forms of inflammatory arthritis that usually have negative blood tests include psoriatic arthritis, enteropathic arthritis, and reactive arthritis.

Donna from the USA asks: Do I need to continue taking folic acid if I have stopped methotrexate?

Folic acid’s role is to reduce the risk of side effects from methotrexate. It does not help treat rheumatic conditions itself. Therefore, in most cases, if the only reason a patient was taking folic acid was because they had been on methotrexate, it would be considered appropriate and safe to stop the folic acid.

Bernie from Calgary asks: I had gout in my left knee in mid-December last year. The Doctor took the fluid out and gave 10mg of Prednisone daily until the uric acid is cleared from my blood. The last three monthly blood tests shown my uric acid is still 650 and I am gaining weight in my trunk and thinning legs. I tried last week to stop taking Prednisone and to take instead Allopurinol. Unfortunately, I began having pain in my knee. What should I do?

Chronic gout is treated using a uric acid lowering medication, such as allopurinol. These medications are the only way to lower uric acid and in doing so, reduce the frequency, duration, and intensity of gout attacks. Prednisone does not lower uric acid, but it does reduce inflammation, including the inflammation from a gout attack. In other words, often the treatment for gout requires a two pronged approach. For the long term, a uric acid lowering agent is needed to prevent attacks. In the short term, a medication to treat attacks when they happen is needed, such oral prednisone, an anti-inflammatory, colchicine or a cortisone injection into the affected joint.

Divya from United Arab Emirites asks: I have had two successful pregnancies but have had increasing joint pain, stiffness and swelling after each pregnancy. A CCP antibody test has returned positive. What is going on?

The time after pregnancy is a higher risk period for the development of rheumatoid arthritis (RA). Conversely, rheumatoid arthritis often goes into remission during pregnancy. A positive anti-CCP antibody is usually associated with rheumatoid arthritis as well. It is important to discuss a treatment plan with your physician or rheumatologist to ensure a good outcome, but also safety for you and baby.

Kerri form Okotoks asks: I had a horrible flu with aches and pain. I still have the pain and it’s 6 months later. What should I do?

Influenza is a type of viral infection. In some individuals, viral infections can cause muscle or joint pain. It can even cause swelling or inflammation in the joint. For most, this resolves over days or weeks. For others, it can continue much longer than that. It is important to determine if there truly is swelling within the joint, as this would change how pain is managed. A physician or rheumatologist, by listening to your symptoms and doing an appropriate physical examination, can often determine the cause and put a treatment plan in place.

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.