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Bethany from Olds asks: My grandmother died from Scleroderma complications at 48 in 1970. I have exhibited many symptoms of Scleroderma for years, and they have all become worse in the last six months. All the general blood tests my GP has access to have come back negative but is still going to refer me to a Rheumatologist. What are the chances I could have Scleroderma even though all my blood work was fine?

Like many rheumatic conditions, a diagnosis of Scleroderma is not always made based on lab tests. A good history and physical examination by a scleroderma specialist – usually a rheumatologist – combined with appropriate investigations, will help lead to the correct diagnosis and treatment plan. While there are a number of blood tests that can be associated with scleroderma, it is possible for them to be negative and still have the condition.

Rasa from Edmonton asks: I have fibromyalgia, but I am having a difficult time getting in to see a rheumatologist. Isn’t fibromyalgia treated by rheumatologists?

Fibromyalgia is a condition that presents with diffuse muscle and joint pain, poor sleep, and fatigue. Some patients also describe stomach ailments and have history of headaches. The symptoms may often be vague, but can be debilitating to patients with it. Rheumatologists often see patients with fibromyalgia before a clear diagnosis has been made. For some people, it is important to rule out other possibilities, including conditions such as rheumatoid arthritis, polymyalgia rheumatica, and other autoimmune inflammatory diseases which require a different treatment approach.

If a diagnosis of fibromyalgia has been established, there is no specific expertise a rheumatologist has compared to other physicians, including family physicians. The first steps in managing fibromyalgia include a slow progressive increase in exercise, working on sleep hygiene, and learning more about fibromyalgia. Please visit our webpage on fibromyalgia to learn more the condition and resources available in the Edmonton area.

Valerie in Edmonton asks: My doctor prescribed diclofenac and I have been taking it for 3 weeks. It sometimes gives me indigestion. Is it alright to continue taking it? I have had a past history of stomach problems and recently started pantoprazole once a day.

Diclofenac is an example of an NSAID (anti-inflammatory). Similar medications include naproxen (Aleve), ibuprofen (Advil, Motrin) or celecoxib (Celebrex). There are many potential side effects of NSAIDs, including irritation/inflammation to the stomach lining. Ultimately, this can lead to a stomach ulcer in some individuals. Medications called proton pump inhibitors (PPIs), like pantoprazole, can help reduce the risk of this happening. However, one should consider stopping the NSAID if the stomach discomfort continues despite being on a PPI. Everyone’s individual risk from NSAIDs is different and should be strongly considered when starting a NSAID. A conversation with your doctor to balance the benefits and risks is always a good idea.

Manjinder from Calgary asks: I have rheumatoid arthritis. Is it ok if I keep working? Is it good for me?

Years ago, the answer to this question would be very different. Older data suggest that half of patients with rheumatoid arthritis will be disabled and unable to work after 10 years with the disease. Today, this is unlikely the case, as treatment for rheumatoid arthritis has improved; our goal of treatment is remission, meaning no pain, stiffness, or swelling, and ideally doing everything you want to do in life. This includes the ability to work. For some individuals, it may not be a realistic goal to work while rheumatoid arthritis is still active, and some find it hard to return to work later on. Ultimately, each person needs to be comfortable with their choice, as there are many different factors to consider when it comes to work. However, work itself is not going to make rheumatoid arthritis worse.

Tania from Edson asks: My family and I are planning our next big trip. I know that the areas I can travel are limited because I take a biologic. Can you recommend a good website or other resource for me to research this in more detail? My daughter hopes to visit all the continents!

For most rheumatology patients whose disease is under control, travel should not be a major issue. Many patients are concerned because they may have medications that require syringes and needles, but your rheumatologist can provide you a travel letter which can be presented if requested by authorities. For patients on intravenous medications, arrangements often can be made to ensure minimal interruption to your treatment. The bottom line is to speak with your rheumatologist; if your disease is under good control, you should be able to lead a full and complete life. If that includes travel, so be it!

Sherry from Calgary asks: I was just diagnosed with Rheumatoid Arthritis. I was prescribed methotrexate and hydroxychloroquine. I am currently in a flare so need to continue with diclofenac to control the pain. Is this drug combination safe?

There are animal based studies that suggest a concern about using methotrexate and any anti-inflammatory, including diclofenac, together. However, this combination is used commonly in patients with rheumatoid arthritis without any significant concerns. It is an appropriate way to control symptoms while waiting for the disease modifying agents, such as methotrexate and hydroxychloroquine, to start working. While all these medications have potential side effects, there are no significant increased risks when used together.

Alyssa from Edmonton asks: What type of inflammatory arthritis occurs in multiple joints and yet shows negative on blood tests for the RA factor?

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.