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Sarah from Edmonton asks:
I have been prescribed Arava and Cimzia for the treatment of rheumatoid arthritis.
I am wondering does taking a biologic or DMARD offer any protection against the development of other autoimmune conditions.
That's a great questions Sarah. While Arava is primarily used for the treatment of inflammatory arthritis, such as rheumatoid arthritis, Cimzia, or certolizumab, is an example of a TNF antagonist. TNF antagonists can be used to treat a variety of other autoimmune diseases. Examples may include in the treatment of inflammatory bowel disease such as Crohn's and colitis, psoriasis, uveitis (inflammation in the eye) and other rheumatic conditions like ankylosing spondylitis. There are many patients who use a TNF antagonist to treat more than one of these conditions at the same time. While being on a TNF antagonist theoretically might reduce your risk of developing one of these associated conditions, there is never a guarantee that they would completely prevent them from happening.
Jessica from Edmonton asks:
I would like to learn more about hyaluronic acid injections. Some website say it is for knee joints only, while others say it can be used in the shoulders, hips and ankles as well. Also, which HA injection solutions are approved for use in Canada? Thanks
Thanks Jessica. Hyaluronic acid is a molecule which is deficient in a joint affected by osteoarthritis. Therefore, the thought is it can bring improvement to the joint if injected. While it likely is used most often for the knee, it can be used for most other large joints as well, including the shoulders and hips. There are many hyaluronic acid products available in Canada; while there are differences in how they are made, there is no clear evidence to suggest one is necessarily better than the next.
Sasi from India asks:
I was diagnosed with rheumatoid arthritis 3 months ago but my rheumatiod factor blood test was negative. I have a raised ESR. I was started on Sulfasalazine.I was just wondering if I have RA at all.
Rheumatoid Arthritis is a clinical diagnosis. This means all your blood tests could be normal and you may still have rheumatoid arthritis. A diagnosis of RA is made based on the information you provide your physician and based on physical exam findings. Further investigations may support the diagnosis, but are not necessary for the diagnosis. Read more about RA here.
Kali from Edmonton asks:
My daughter who is 18 has had IBS since she was 5 and was just diagnosed with Fibromyalgia. They did not do any lab tests at all to confirm it was not rheumatoid arthritis. Is this common? Should I insist on lab tests? I am worried because I do have RA.
Kali, as we have previously discussed (see below), there is no one blood test that can confirm a diagnosis of rheumatoid arthritis. In fact, many individuals have rheumatoid arthritis with completely normal blood work. Rheumatoid arthritis is diagnosed by an expert physician based on a patient's symptoms and physical exam findings. While your daughter is at an increased risk for RA because of your family history, her overall risk remains low. The most important thing you can do is ensure she does not smoke, as smoking has been shown to increase the risk for developing rheumatoid arthriits.
Sarah from Edmonton asks:
How do rheumatologist decide which biologic to use first? Personal/Patient preference, etc??
There are many factors that may decide which biologic is used first, and this is a topic which has become more complicated over the last few years with the introduction of more biologic options. Most rheumatologists will consider a TNF antagonist as a first biologic, often because currently, these have the most information available for how well they work and their safety. Over time, this will likely change as newer non-TNF biologics are used more and more. For some patients, TNF blockers are not considered a safe option and another biologic will then be considered. Amongst the TNF antagonist options, they are generally very similar in how well they work and how safe they are. There are some small differences, but for most patients, these are not important from a medical point of view and it can come down to patient preference. The other important factor to consider is cost. Biologics remain an expensive medication and sometimes the patient's medication insurance coverage can influence the choice. However, most rheumatologists will ensure this does not prevent patients from getting the medication they need when they need it.
Ivonne from California asks:
I am seeing a doctor who thinks I have lupus but hasn't diagnosed me; he wants me to see a rheumatologist but it's going to take time for me to be able to afford one. what does it take to get diagnosed?
There is no one particular test to absolutely diagnose systemic lupus. It requires you to meet with a lupus specialist, usually a rheumatologist, to go over your symptoms, do a complete physical exam and look at this in combination with a set of blood tests. Unfortunately there is no simpler way. For more information on how lupus is diagnosed and treated, click here.
Cally from Edmonton asks:
My mother was diagnosed with Behcet's two years ago. She is having a lot of issues with her lungs (vasospasm due to chronic inflammation) and the puffers her GP and emergency doctors gives her only provide minimal relief. Her rheumatologist said her lung issues were unrelated to Behcet's but according to my research it is.
For our other readers, Behcet's disease is a condition of unknown cause which most commonly manifests as painful sores in the mouth and/or gential region. While not as common, it can also demonstrate eye involvement, skin lesions, neurological findings, arthritis and blood vessel changes. While lung problems have definitely been reported with Behcet's, it remains unclear whether these are incidental findings where one person has two separate conditions, or if there is a true relationship. While a rheumatologist is an expert in Behcet's disease, a lung specialist may provide the best insight into any lung issues.
Louise from Edmonton asks:
I have had Rheumatoid Arthritis for 40 years. Does it ever go away?
As of 2012, there is still no cure for rheumatoid arthritis. However, our ability to treat RA more effectively has dramatically improved. Many individuals who are diagnosed with RA today can go into complete remission with medications. In the last 10 years alone, the way we treat RA has seen great improvement, with many new and exciting treatment options, and better ways to use well known medications as well.
Shannon from Calgary asks:
I was wondering if there is any link between diet and arthritis? Are some foods known to cause an inflammatory reaction?
This is a very common question we get asked. The link between diet and arthritis is not well described. There is some evidence that Omega 3 fatty acids may benefit those with inflammatory arthritis, such as rheumatoid arthritis, with Omega 6 and Omega 9 having an opposite pro-inflammatory effect. For osteoarthritis, a well balanced diet which maintains an appropriate body weight is ideal, as we know being overweight does contribute to arthritis. Finally, we know smoking is bad for joints, and in particular can increase your risk for rheumatoid arthritis.
Sandy from Busby asks:
What can I take to relieve nausea while taking medication for rheumatoid arthritis. I am taking sulfasalazine, chloroquine, and methotrexate, as well as an anti-inflammatory?
Most medications, whether for arthritis or not, have nausea or stomach upset as a potential side effect. It is important to discuss nausea and any suspected side effect with your rheumatologist as they may be able to determine which medication specifically is causing the problem and make an adjustment accordingly.
Brenda from High Level asks:
Once youve been started on a biologic fror Rheumatoid Arthritis and the changes in symptoms after two years are not significantly improved, do you have to stay on a biologic?
This is a very complicated question. As of 2012, there is still no cure for rheumatoid arthritis. Our goal is put RA into remission, meaning no stiffness, pain or swelling while improving function and limiting joint damage. If a patient has truly not reached this goal, or at least has not seen significant improvement, it may be worthwhile discussing alternate options with your rheumatologist. However, there can be other reasons why there has been a lack of perceived improvement. For example, as many as one-third of RA patients also develop fibromyalgia; while the RA goes into remission, the fibromyalgia remains, making it appear there is still inflammation. For others, there may be significant improvement in RA activity, but not 100%, meaning it still feel active. In this case, it may be worthwhile reviewing and optimizing the current medication regimen.
Ray from Edmonton asks:
I have what has been described by my family doctor as Heberden's nodes on one finger of my left hand. The area fills up with a clear jelly like fluid and needs to be drained regularily to relieve the pressure and eventual pain. Is a referral required to see a rheumatologist to have this problem further assessed?
A Heberden's node is a bony enlargement of the most distal joint in a finger. It is most associated with osteoarthritis, which you can read more about here. A Heberden's node can be painful, but typically is not fluid filled.
Wendy from Fort Lauderdale/, U.S.A asks:
I've been recently diagnosed with systemic lupus, sjogren's syndrome, and nephrotic syndrome and I'm still trying to wrap my head around everything. I haven't received really any education only management or much about how the diseases may impact me. What should I expect from a rheumatologist in general but especially in regards to education?
Different rheumatologists have different ways they run their practise. Many ensure they become the primary care provider for any concerns and questions around the rheumatologic diagnosis. Often, but not always, it is the rheumatologist's task to ensure you have the information you need when it comes to your rheumatologic diagnosis. Sometimes, this education is provided by the rheumatologist him or herself. Sometimes, they may first ask you to review websites like ours, or have an education program available for you to attend.
Kathryn from Drayton Valley asks:
How do I get an appointment with a rheumatologist? Will they do test to determine exactly what type of arthritis I have?
To see a rheumatologist in Alberta, a patient usually needs their family doctor to send a referral letter with a specific question or concern. As you may have noticed from exploring some of our webpages, most types of arthritis are best diagnosed by your rheumatologist taking a good history and performing a physical exam. There are a number of blood tests ann/or imaging tests that could be considered as well, but this is guided by the information obtained from your clinic visit.
Lynn from Sherwood Park asks:
How can what looks like minor swelling in my wrists and hands cause such a huge amount of pain? I didn't think it was possible for a limb to be in so much pain, short of a catastrophic injury. Is it just me, or is it fairly common for people to have a great deal of pain when RA "flares up"?
Rheumatoid arthritis is a disease which causes pain, stiffness and swelling. Each patient experiences these symptoms differently, but many describe a great deal of pain. Remember, the amount of swelling that is present does not always correlate with the pain it causes. The mere presence of swelling can cause a significant amount of pain.
Marissa from Edmonton asks:
With lupus, is it ok to get pregnant and have a normal pregnancy or do you have to be cautious or is it not possible? I don't want to be on medication.
Please check out our new information page on this topic here. The most important thing is to discuss your pregnancy plans with your rheumatologist to ensure a safe and healthy pregnancy.
Brian from Edmonton asks:
Is it important to see your Rheumatologist after starting a new drug such as the Biologics?
Yes, it is important to see your rheumatologist after starting a biologic or any DMARD medication. With your rheumatologist, you need always review your medications to make sure they are working effectively and they remain safe.
Tony from Spruce Grove asks:
I have been suffering pain in both toes beside my big toes on both feet. It started in my left foot which was diagnosed as juvenile arithitis at 16. I'm 43 now and it seems to only "flare up" on occassion in the last year or so really bad. My eating habits aren't the worst or bad in many ways but it seems to not be any better after taking a prescription that the GP described.
There are more than 100 different types of arthritis. While some have similarities, many have different treatment regimens. For instance, the treatment for juvenile arthritis and gout are very different from each other. The most important thing is ensure the right diagnosis - that will ensure all patients get the right treatment.
Monica from Edmonton asks:
I was diagnosed with RA and am on the methotrexate/Plaquenil combination. Others I know also on these drugs were told they needed to take calcium as well. Should I be taking calcium supplements?
Patients with rheumatoid arthritis do have an increased risk of osteoporosis, or thinning of the bones. Ensuring appropriate calcium and Vitamin D intake can help reduce this risk and it is best to discuss an appropriate dosage with your rheumatologist. Calcium supplementation itself will not help treat rheumatoid arthritis.
Margaret from Edmonton asks:
I have been taking methotrexate(by injection) and plaquenel for nearly 6 months. I have had what I can only describe as a dry cough. It is a feeling that I need to keep clearing my throat and at times have trouble with my voice where it just isn't very strong. Could this be a side effect of one of the medications? If so what can or should I do about it if anything?
A rare risk of methotrexate is to causing scarring to the lungs. Sometimes this can manifest as unexplained shortness of breath or a cough. Most rheumatologists will ask their patients to contact them if they have any concerns in this regard. In most cases, it is merely a coincidence as again, this side effect is rare.
M.J. from Calgary asks:
I have many signs and symptoms of Limited Scleroderma but my test for the antibodies came back negative, so no diagnosis. I've read that eventually the antibodies will increase. Is that true? Would getting retested yearly be logical? Or is there another way to get a diagnosis?
Scleroderma is best diagnosed by a specialist with training in scleroderma... most often this is a rheumatologist. The diagnosis is primarily made based on your story and the physical exam findings. While there are blood tests which are highly associated with scleroderma, blood tests for scleroderma do not have to be positive to have scleroderma.
Marie from Edmonton asks:
Whenever I visit a health specialist with regards to my rheumatology one of the questions asked is "Am I depressed?" I never am and am wondering why they would always ask that question.
Many rheumatic diseases are associated with higher rates than usual of depression, including rheumatoid arthritis, osteoarthritis, fibromyalgia and ankylosing spondylitis. Often this may correlate with disease activity - if your body feels down, your mind may feel down too - or with your ability to cope with a chronic medical condition. Good coping skills and hopefully good disease control may counteract the risk of depression and it sounds like this may describe you.
Chris from Edmonton asks:
I believe I have undiagnosed Sjogrens Syndrome. Is it worthwhile for me to get an official diagnosis?
Individuals with Sjogren's Syndrome most often describe dry eyes and dry mouth which is quite severe and without other explanation. Some will also describe both local joint pain or more diffuse pains, changes in feeling or strength, bowel changes, skin rashes and more. Sjogren's syndrome can range from a very mild disease treated symptomatically to a life threatening condition if not properly treated. It is therefore worthwile to discuss this further with your family physician.
Judi from Washington DC asks:
What is the connection between food and gout? What is the suggested diet for gout control?
Gout is caused by excess purine levels - a protein found most often in meat - which causes higher levels of uric acid in the blood. Purines are difficult to avoid, and a purine free diet would leave you with a poor diet with limited choices. While reducing purine intake will lower your uric acid a small amount, it may not be enough to prevent further gout attacks. However, if you notice a specific food seems to cause a gout attack everytime you have it, it would make sense to avoid it. Examples may include a specific type of meat, nuts, etc. For more information, visit our webpage on gout.
Margaret from Edmonton asks:
Would it be a good idea for a person with Rheumatoid Arthritis (on plaquenel) to get the vaccine for shingles?
In general, any "live vaccine", including the vaccine for shingles, requires caution if you are on an immunomodulating agent. There is greater concern with individuals on stronger DMARDs such as methotrexate, leflunomide or biologics. You should always discuss this with your rheumatologist prior to getting a live vaccine. The injected flu shot (not the spray) and vaccine for pneumonia and hepatitis are all safe vaccines in the setting of rheumatoid arthritis and any treatment option.
Anonymous from Canada asks:
I was diagnosed with SLE, and have been taking plaquenil. Will I ever be able to go off of this medication? Is there any natural diet/foods I can take instead?
To read more about plaquenil, click here. Overall, plaquenil is a very safe medication. For lupus, it can effectively treat the so called milder components of the disease, including joint and skin symptoms. However, there is reasonable evidence that individuals who take plaquenil have a reduced risk of developing more serious and life changing organ involvement (e.g. kidney disease). It is for that reason that many rheumatologists will suggest you remain on plaquenil. As of today, there are no natural products that bring similar benefit to lupus patients as plaquenil.
Tammy from Fort Saskatchewan asks:
I am wondering if there is any connection between hypothyroidism and fibromyalgia? I was recently diagnosed with fibromyalgia and I am hypothyroid already. The pain I feel in my body, especially my legs is almost unbearable.
Fibromyalgia is a diagnosis of exclusion, meaning there cannot be another medical explanation for its symptoms. One of the tests that should be done prior to a diagnosis of fibromyalgia is to ensure the patient does not have any form of thyroid disease, and if they do, to ensure it is well controlled. Certainly, untreated hypothyroidism could have some symptoms that are similar to fibromyalgia.
Deborah from Edmonton asks:
I have chronic muscle and joint pain, which is worse when I wake in the morning and in the evening or if I am inactive. Sometimes I
can barely get up off the chair. I also suffer from headaches and fatigue. My doctors THINK I may have fibromyalgia but, of course there is no test to determine this. Where do I go from here?
Fibromyalgia is a clinical diagnosis. There is no test for it, and in fact, your tests should be normal. In patients where alternatives have been ruled out, and the diagnosis of fibromyalgia is suspected, an appropriate treatment plan should be put in place. This should include a slow progressive increase in exercise and further education about fibromyalgia.
Debbie from Calgary asks:
My father in law had RA, my husband has RA and so do I. Will our 3 children be at greater risk for developing RA?
First degree relatives of an individual with rheumatoid arthritis are at higher risk for developing RA themselves. However, this risk is not substantial; it is more likely they will not have rheumatoid arthritis than they will. Smoking also increases your risk for RA and it may be advisable that first degree relatives do not smoke as genetic susceptability and smoking will greatly increase the risk of developing rheumatoid arthritis.
Trish from Edmonton asks:
I have positive ANAs and have just experienced a miscarriage that I believe may be related. I have read that positive ANAs can cause recurrent
miscarriages and am scared that this will happen again. Are there any treatments that reduce the risk of miscarriage with an unspecified autoimmune disease (not SLE, no RA)?
A positive ANA, or anti-nuclear antibody, can be used as a marker for a number of autoimmune diseases. However, on its own, there is no evidence that it causes disease or miscarriage. If an autoimmune disease is suspected, an evalution by a trained medical specialist may be appropriate. Only when an autoimmune disease or other cause for a miscarriage is identified can any specific treatment plan be considered.
Patricia from Edmonton asks:
I am recently diagnosed with gout and taking for the last 18 months Allopurinol daily and Cochicine when needed. How long does it take to lower Uric Acid? Would a dietician be of help?
If the dose of allopurinol is correct, uric acid should be lowered within 4-6 weeks with the full effect - decreased gout flares - noted within 3-6 months. If the uric acid is not properly lowered, than consideration should be given to raising the dose of the allopurinol. A dietician may be helpful in some cases to review foods that may have a greater effect on uric acid levels but as a general rule is not necessary.