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.

Jeanette from Edmonton asks: I recently saw a rheumatologist who says I don’t have inflammatory arthritis because there is no swelling on exam. Is that truly the case?

In most situations, a rheumatologist can detect swelling in the joints on a physical exam, assuming there is swelling, which helps make a diagnosis of inflammatory arthritis (rheumatoid arthritis, psoriatic arthritis, etc.) However, it is never that simple. Equally important is listening to how you describe your joint pain, stiffness and swelling; and there are situations where the history, in the absence of swelling, leads the rheumatologist to do more testing (for example, ultrasound). In most cases, when a rheumatologist says someone does not have inflammatory arthritis, it is because the symptoms do not quite fit AND there is no swelling on exam.

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.

Natasha from Ontario asks: Is Rituximab coverage for Rheumatoid Arthritis in Alberta?

Yes, rituximab biosimilars are covered by the provincial drug plan in Alberta. In fact, all biologics listed on our website are covered by the provincial plan for inflammatory arthritis.

Tara from Alberta asks: I am looking for information on both Sjogren’s Syndrome and Rheumatoid Arthritis. Is there more information available on them?

We have information on our website on Sjogren’s and Rheumatoid Arthritis, and videos on specific items on both on our YouTube page. Having the symptoms of both of these conditions is not uncommon. A significant minority of individuals with RA have secondary Sjogren’s syndrome, and of course, Sjogren’s syndrome itself can cause an inflammatory arthritis similar to rheumatoid arthritis. Fortunately, there is also overlap in the treatment options for a number of the symptoms of these conditions. Working with your rheumatologist, significant improvement in symptoms should be achievable.

Jeanine from Sylvan Lake asks: Are cataracts associated with rheumatoid arthritis?

Rheumatoid arthritis can have a number of manifestations within the eyes, including scleritis, sicca symptoms (dryness), or even vasculitis. While not as common, cataracts can occur, although this may be more due to steroid use (e.g. prednisone) than the arthritis itself. Cataracts itself is also relatively common in the general population: those aged between 40-50 have a 5% rate of developing cataracts, so it is possible to coincidently have both. The most important thing to do from an arthritis point of view is to ensure your arthritis is under good control. If you have no inflammation, the chance the arthritis is affecting your eyes is low.

Ammar from Alberta asks: Biologics are expensive! How do I make sure the cost is covered?

Biologics are expensive! They can range from $10,000 to $25,000 per year. No one can afford that, which is why having insurance coverage for these medications is important. Most insurance plans have rules which must be followed to have these medications covered. Most of these rules are reasonable. For instance, for rheumatology problems, biologics must be prescribed by a rheumatologist. You must have a disease that we know is treatable by a biologic. You must have tried other medications first which we know may work as well (e.g. methotrexate) before trying a biologic. And finally, we must show that the condition has improved on a biologic. Working with your rheumatologist, there is nearly always a solution to finding funding for biologics. If you are having troubles, make sure your rheumatologist knows.

Mona from Calgary asks: I don’t see anything about Rinvoq. My rheumatologist has suggested that one for me.

Rinvoq, otherwise known as Upadacitinib, is part of a newer class of advanced disease modifying medications for inflammatory arthritis called JAK Kinase inhibitors. To learn more about it and the other JAK Kinase inhibitors that are currently available, visit our webpage here.

Emma from Canada asks: I received my 2 doses of the Moderna vaccine and with the first experienced a 1 week rheumatoid arthritis flare but it was manageable. After the 2nd dose, my RA took a turn for the worst & I have been in the worst flare of my life since (4 months now). Should I still get the booster?

The best advice for anyone in this situation is to speak with your rheumatologist. Regardless of the vaccine, a flare lasting more than a few weeks deserves a conversation with your rheumatologist to determine the best course of action going forward to get it under better control. That said, while there is some evidence that the COVID vaccine may induce flares in a small minority of cases, most times the flare is either a side effect of the vaccine but perceived as a flare (likely what is described after the first shot) or a coincidence of association, rather than causation. As so many people are getting COVID vaccine, it will happen that some will flare afterwards, but it is likely that many of those flares would have happened anyways. As a general principle, 3rd (and now 4th) shots for COVID vaccine are encouraged for those with rheumatic diseases.

Erin from Jasper asks: My dentist diagnosed me with rheumatoid arthritis based on findings in my TMJ joint. What should I do now?

Rheumatoid arthritis is a systemic disease and whether or not it impacts one joint or many, it should be ideally managed by a rheumatologist. Rheumatoid arthritis is a condition that can be placed into remission with the right treatment. If not already, you should speak to your family physician or dentist about a referral to a rheumatologist to ensure there are no other joints involved and treatment options are discussed. In Alberta, all rheumatologists require a referral.