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.

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.

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.

Jackie from Albuquerque asks: I am worried I may have been exposed to HIV. I also have rheumatoid arthritis and am on a biologic. I have tested negative for HIV, but could my biologic be interfering with the results?

There are a number of different tests for HIV. Some could be impacted by a biologic in early infection, although data is not clear. To be sure, it is best to discuss this with your physician and rheumatologist. Conversely, it is important to be aware that being on a biologic can increase your risk of a more active HIV infection.

Fanchi from Edmonton asks: I may have rheumatoid arthritis but have not been diagnosed yet. What can I do, if my symptom continues, before I meet a rheumatologist?
If I have to use expensive biologic DMARD, is there any way to find some insurance plans that can cover most of the cost?

For patients with rheumatoid arthritis, the use of disease modifying medications is key to control symptoms AND more importantly, the underlying disease. For a variety of reasons, it can take time for them to work, but there are other options to control symptoms, such as pain, while waiting. While best to discuss with your own physician, anti-inflammatories (NSAIDs) are a good first choice for many patients, such as ibuprofen or naproxen. Sometimes, cortisone injections into particularly painful joints, or even a short course of prednisone by mouth, could be used. Physical therapy also has an important role to protect joints in this early phase of rheumatoid arthritis.

While expensive, rheumatologists in Alberta are usually able to work with patients to find a way to fund biologic medications. It would be unusual to not provide needed treatment because of funding issues for most patients with rheumatic diseases in Alberta.

Linda from Canada asks: My rheumatoid arthritis doctor mentioned that I have erosions. Could you please explain this…how serious is it? Is there something one can do for it?

Rheumatoid arthritis causes joint pain, stiffness, swelling, functional impairment, and if not controlled quickly enough, it can cause permanent damage to the joint. The first sign of permanent damage is an erosion, a small bite out of the bone about the joint. A small bite of the bone is not something that a person will notice, but if it continues to develop bigger and there are more of them, it can cause significant deformity in the future. Once an erosion occurs, it cannot be reversed. However, aggressive treatment to control rheumatoid arthritis can prevent further damage from happening.

Daniel from Edmonton asks: My friend has psoriatic arthritis. He is in a lot of pain and is getting treatment to help deal with his condition. One thing he would like to do is start a fitness routine to help. I’m looking for advice on how to help plan and work in a fitness routine that could account for his joint pain.

Great question! We encourage our patients with inflammatory arthritis to stay active despite having arthritis. We know that maintaining activity and muscle strength is a positive, and can be an important component of treatment and well being. Further, activity itself should not make the arthritis worse. That said, every individual is different and we need to ensure an appropriate balance between remaining active and not causing pain. Physical therapists with expertise in inflammatory arthritis are often involved in consulting and developing activity plans. Your rheumatologist should be able to recommend an appropriate physical therapist to you.

Dallas from Alberta asks: I have been on methotrexate for 5 months and started to notice that I am losing my hair. What should I do?

While not a common occurrence for most people on methotrexate for their arthritis, hair loss certainly is a known side effect. Certainly this should be discussed with your rheumatologist to determine the best option in any particular case. For some, increasing folic acid intake may be quite helpful at reversing the hair loss. For others, lowering methotrexate or considering an alternative may be necessary. Making the appropriate adjustments with your rheumatologist will ensure the best chance of reducing any side effects while still ensuring your arthritis is, or becomes, under good control. Keep in mind, even if the hair loss stops, it unfortunately can take months before you notice the improvement. Hair loss from methotrexate is usually reversible; hair will grow back.

Deb from Edmonton asks: What causes hip involvement in rheumatoid arthritis?

Rheumatoid arthritis can involve essentially any joint in the body with few exceptions. This includes both small joints, such as those in the hands and feet, as well as large joints, such as the shoulders, knees, and hips. Treatment typically is the same regardless of the joints involved.

Tara from Edmonton asks: I tested positive for Sjogren’s syndrome and Rheumatoid Arthritis. Can you please tell me something about them?

Sjogren’s syndrome is an autoimmune disease with its most common symptom being dry eyes and dry mouth. Read here for more on rheumatoid arthritis, and check out this previous answer for more information. However, you should know there is no definitive test for rheumatoid arthritis or Sjogren’s syndrome. There are tests that are associated with these conditions, but they are not definitive. To make a diagnosis of most rheumatic diseases, including rheumatoid arthritis and Sjogren’s syndrome, an expert in these conditions needs to take a good history and complete a physical examination; then, it is appropriate to look at any investigations and determine how they best fit all together. There are many patients we see who test “positive” for these blood tests, but don’t have – and may never have – a rheumatic disease.