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Answers tagged rheumatoid arthritis: Page 1 of 6
While biologics can be very effective at treating rheumatoid arthritis, they typically are not considered the first choice. In most cases, methotrexate remains the gold standard treatment. This is not just because it costs less, but in fact, when studied head to head, methotrexate works just as well as biologics do. When combined together, methotrexate and biologics are more effective. Overall, methotrexate is likely a safer option compared to biologics; and, well over 50% of individuals will go into remission on traditional DMARDs like methotrexate without needing biologic medications.
While rheumatoid arthritis can potentially affect nearly every joint in your body, the one area that is uncommon to be affected is the lower back. If someone has lower back pain and rheumatoid arthritis, the lower back pain is more often mechanical in nature, or “normal” back pain. That said, other forms of inflammatory arthritis – like psoriatic arthritis, ankylosing spondylitis and others – can involve the lower back. Sometimes, it is difficult to know what type of arthritis someone has. Inflammatory back involvement can be an important clue to help.
Beth from Lloydminster asks: What is the difference between an internal medicine specialist and a rheumatologist?
An internal medicine specialist is a doctor for adults who can diagnose and manage a wide variety of complex and multi-system diseases. As part of their training, they will complete rotations in many different areas of medicine, often including some time in rheumatology. To become a rheumatologist in Canada, a doctor first completes core internal medicine training before receiving at least 2 years of further subspecialty training exclusively in rheumatology. While having a rheumatologist manage a rheumatic condition is ideal, there are certainly situations where having an internist involved may be a good choice in care. Any type of doctor – including internist and family doctors – can refer individuals to a rheumatologist for care.
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.
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.
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.
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.