Could it still be RA?

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A couple months ago I posted about my first rheumatology appointment and blood work results. All tears came back negative with the exception of a slighted elevated RF. Despite my having arthritis in several joints including back, hips, and knees (only joints X-rayed), my doctor said she didn't feel it was RA because my hands were not affected and I didn't have noticeable swelling. At this time I was given a diagnosis of fibromyalgia.

Since then, I have had to have two cortisone injections in my hips, and have been diagnosed with Achilles tendinitis. I am only 38 years old and in the last two years I have had my ACL reconstructed, hip surgery in both hips for labrum tears and bony abnormalities, subsequent MRI on one hip shows further degeneration of the labrum, and now have the tendinitis in my Achilles with several bone spurs on my heel. This weekend, one of my knuckles started swelling out of the blue. My hand as been so stiff and sore. Does this sound like more arthritis? Is this the hand swelling she was talking about? I emailed her a picture of it but haven't heard back. I just feel like she patronizes me and made it Sound like I was making up symptoms based on what I read on the Internet.

For those of you with an atypical RA diagnosis, does any of this sound familiar? I just want to figure this out as I can't take the pain and disability anymore without answers. I am fit and active but have had to decrease my workouts from 5 days a week to only 2 and I am in horrible pain afterwards. This is taking a toll on my mental well being and I need to get back to me.

Sorry this is so long, I just feel like I have to get it all out because I have no one else to talk to who gets it. Thanks!

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  • Posted

    Some of the symptoms you are describing sound like osteoarthritis. It is osteoarthritis that gives you bone spurs. That being said it is quite possible to have both forms of arthritis. I do! And its crap!!

    The pattern for osteo is damage to the cartilage due to wear and tear. This exposes bone which rubs against other parts of the joint causing heat, pain and swelling. The bone forms scars called spurs which further jam up the joint and the cycle of damage and inflammation repeats itself.

    The pattern for RA is inflammation first as the immune system gets its wires crossed and attacks the body its supposed to be defending. The chronic inflammation eats through the cartilage and into the bones which scar badly and twist the joints.

    Please note that RA does not always start with the hands. For me it was my knees, finger joints came later.

    You say you used to regularly work out. Is any of this high impact? Not meaning to be a negative nancy but once you get into your 30s your body starts to lose its ability to bounce back like it once did. Plus damage from years ago begins to tell as joint spaces shrink with age. Both types of arthritis benefit from rest and any exercise should be low impact. This is not the sort of pain barrier you should be pushing through. RA particularly punishes heroes.

    As for your test results, 20% of RA sufferers test negative for RF. What was your CRP (measures inflammation) and your white blood counts (measures immune system activity)? These are usually high if RA is active.

    Don't be afraid to get a second opinion. General practitioners don't always know enough to make trickier diagnoses.

    What did the rheumatologist say? It sounds as though you are short of information about your own case. Keep asking until you get it. You can't move forward until you know what you're dealing with.


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  • Posted

    "I just feel like she patronizes me" - then it is time to find another doctor. You will never have a happy relationship with someone you feel like that about. I don't know what healthcare system you are in but it is usually possible to have a second opinion somehow.
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  • Posted

    From where I'm looking this does not sound like RA. I have RA negative factor, which is common in 20%.

    RA is usually bilateral and you seem to say your swellings are on one hand. Also, bone spurs are not a normal symptom, as far as I know, though nodules on the knuckles might be.

    Your rheumy is right in that usually symptoms first appear on the hands and wrists, and the hands are normally the first to be x-rayed to have a base line with which to later check for deterioration.

    How about fatigue? Early RA symptoms are often accompanied by severe fatigue, in my case in the mornings, about 3 hours after rising.

    In some ways, despite huge pain everywhere, the fatigue was the worst of it.

    Also, as far as I understand, RA rarely if ever manifests in the back...

    Sorry you're in so much pain. And if you are in horrible pain after your workouts, it doesn't sound like a wise thing to do to continue them.

    One sign of RA is that it starts bad and slowly gets better during the day, after movement. I don't know what your workouts consist of, but you should feel better not worse.

    So these are all clues... Let's see if others corroborate this.

    I wish you well...

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  • Posted

    I also feel for you.  I have RA in my wrists and knee.  It is bearable now with methotrexate and plaqunil.  But being 66 years old I have had shoulder pain for 18 months and it is not RA.  The RA medicines doesn't change the shoulder pain at all.  I did have a shot in the shoulder that helped and I am taking tart cherry capsules.  The tart cherry is pretty cheap and I have seen a little less pain.  Good luck.
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