Kate from the United States asks: Is it normal to just try one biologic for inflammatory arthritis, or should more than one be tried until things feel better?

When it comes to inflammatory arthritis, like rheumatoid arthritis, psoriatic arthritis and others, the goal of treat is remission – no pain, no stiffness, no swelling, doing all the things in life that you want and prevent damage. We try to do this using DMARDs – both conventional ones like methotrexate or hydroxychloroquine, or any of our newer biologics. It is relatively common to try some of these in combination to get better effects. It is also common that we need to keep trying different DMARDs – including different biologics – in different combinations until we get it right and you feel better. While we typically only use one biologic at a time, trying more than biologic is very reasonable if the first one does not work. This of course assumes no other side effects or safety concerns because of other health problems one may have.

Sydney from Leduc asks: I notice some rheumatologists have ultrasound in their office, but not all. Why is this not commonly available for everyone?

Point of care ultrasound (versus ultrasound done at a radiology centre) is becoming more commonly seen in rheumatology offices. It is still not considered standard of practice for rheumatologists, as those rheumatologists who offer ultrasound should have undertaken extra training to ensure they are competent and able to accurately interpret the images. Ultrasound is not necessarily needed for all patients. For most individuals, a good physical exam provides the needed information to make a good plan for managing your arthritis. In some cases, it can be helpful, which is when a rheumatologist who does not do ultrasound themselves will either ask their colleague to perform the test, or have the patient assessed at a radiology centre.

Cherri from Alberta asks: I joined the Patient Advisory Council but haven’t heard anything yet. Is this legit?

We soft launched the Patient Advisory Council about a year ago with a fantastic response so far. We have over 100 individuals who have signed up and are receiving our quarterly newsletter. To sign up, you provide your information here, and then you need to confirm with an email we send you. While right now it’s only a newsletter, we have big plans as we know we need to do a better job, by working together, raising awareness for arthritis care in Alberta, advocating for the best resources and ensuring everyone understands the impact arthritis and rheumatic diseases have. Arthritis is the most common symptomatic chronic disease and we need everyone to understand that.

Linda from Alberta asks: I have been diagnosed with RA and find my joints are making noises like cracking a knuckle. Is this normal or common?

Regardless of the reasons, noises coming from joints are usually not a concern, unless they are also associated with pain. If you are having pain, you can discuss this with your rheumatology team to see if there is something more than needs to be investigated or treated.

Steven from Sherwood Park asks: What is the best supplement for arthritis?

Unfortunately, there is probably not one best natural supplement for arthritis. There is still limited data to help tell us if a particular natural supplement may help arthritis, which type of arthritis, and what risks there are. That said, we have compiled a list of supplements our patients commonly use with the available research and risks as they exist today. Hopefully this helps.

Julie from St. Albert asks: Is ESR used to diagnose or monitor inflammatory arthritis?

ESR (erythrocyte sedimentation rate) and more recently, CRP (C-reactive protein), are tests that can detect inflammation in the body. They are not perfect tests. It is possible to have normal results and have active inflammation. It is also possible to have active inflammation which is not related to inflammatory arthritis. For example, an infection will cause these tests to be elevated. These tests typically do not make a diagnosis of inflammatory arthritis on their own, but can help put a picture together of a diagnosis. They can also be used to help monitor how the arthritis is doing, but again, it must be used with other information as well. A normal or elevated test on its own does not mean arthritis is active or not.

Karen from Canada asks: Can I use acetaminophen (Tylenol) with Methotrexate?

Assuming no other medical problems, there is no concern using acetaminophen when you are also taking methotrexate. As long as you are not taking more than the maximum dose, and doing the bloodwork monitoring suggested by your rheumatologist, there is little risk to take both. However, if you need acetaminophen, you should discuss this with your rheumatology team to ensure your pain is not a result of active inflammation, in which case, there may be other medication options which are more appropriate for the situation.

Jody from Edmonton asks: I am worried I have symptoms suggestive of rheumatoid arthritis but all the tests come back negative. What should I do?

Diagnosing rheumatoid arthritis is a clinical diagnosis. While there are blood tests and imaging (including x-rays, ultrasound or MRI) which can be helpful to make the diagnosis, it is possible to make a diagnosis even when all these tests come back normal/negative. Your story and physical exam are critical and should not be ignored. Having a referral to the rheumatology team to listen to your story and determine a diagnosis is a great next step.

Donna from Edmonton asks: Which biosimilars are covered in Alberta?

We are fortunate that ALL biosimilars in rheumatology are essentially covered through the provincial drug plan. You can see the options available here for TNF blockers, with more to be available in the coming months. Work with your rheumatologist to find the right medication for you, especially now with so many options available.

Glenda from Fort Saskatchewan asks: Where can I make a donation for Sjogren’s syndrome and its complications?

There are many great organizations that are doing excellent research, including locally in Alberta. Currently there is a growing research program examining connective tissue diseases, including Sjogren’s syndrome, at the University of Alberta. In fact, both the University of Calgary and University of Alberta are well known for the overall quality of research that is produced when it comes to rheumatic conditions.

To consider a donation, you can visit our donation page here or contact the University of Alberta’s Division of Rheumatology division director and administrator, using this link, to make arrangements. Supporting arthritis and rheumatology research will make a significant difference for tens of thousands who are fighting these conditions every day!