It's rheumatoid arthritis
Posted , 9 users are following.
I don't know how many of you will remember me having been on here many times with questions and concerns and problems tons of problems. Well I had an MRI done yesterday on my right hand. My rheumatologist requested that because it was hurting the most of my two hands. I have been experiencing horrible joint pain the last couple of weeks. And I suspected that it could be from Sjogren's syndrome but I can't get in to have a lip biopsy done for a couple of weeks. Anyway my rheumatologist just called me to tell me that the MRI showed rheumatoid arthritis or actually they called it inflammatory arthritis on the report she's the one who said rheumatoid arthritis. She even said I might be able to get off the prednisone. I think she's thinking I don't have PMR but instead I have rheumatoid arthritis. Personally I think I still have PMR in addition but I'll just have to wait and see. I'm going to see her in the office on Tuesday next week where she has to do some kind of testing and reporting. I know she mentioned testing for lupus. And this is to get Medicare to pay for my medication for the rheumatoid arthritis. It's basically a bunch of hoops she and I have to jump through so that I can get the proper treatment covered by insurance.
1 like, 30 replies
Daniel1143 amkoffee
Posted
i mention this because diagnosis in rheumatology feels a bit like blood-letting. They really don’t know,and draw conclusions through a process of deductive reasoning. I really conclusions can be rather soft. So as much as hte MRI may have offered some clarity, I would be cautious about calling it proof.
Michdonn amkoffee
Posted
amkoffe, once again good luck on your journey, what ever it is. Isn't a shame we have to play games to get the insurance companies to pay our claims. I hope you have the answers to your problems shortly, have courage think positive, it must be hard, but you are making progress. 🙂
EileenH amkoffee
Posted
I do hope this turns out to be your answer amkoffee - I've often thought there was something more going on. The MRI IS pretty much proof - it shows the early degenerative changes in the joints that are conclusive. There are no 100% reliable blood tests att his stage - although the hope is always to prevent progession to the damaged joints.
It isn't uncommon for someone to be told it is PMR and then later have the dx revised, for about 1 in 6 it is to LORA. They can both present very similarly in the early stages before the joint damage starts. One clue tends to be that the response to pred is less dramatic or that symptoms return at a very early stage when reducing. Either should prompt a rethink - it may not be the case, and maybe the RA symptoms remain well managed at low doses of pred, it does happen and there are studies about it.
But once they do see degeneration it is time to switch approach.
Perhaps this helps?:
"Plain radiography is not a useful investigation in early RA as X-ray images usually remain normal for at least 6–12 months after symptom onset [9]. The initial pathological changes develop unseen, leaving the clinician to manage the patient according to the degree of joint inflammation while guessing at the amount of underlying articular damage. In contrast, MRI provides a window through which we are able to witness the disease process unfold from the time of presentation. Bony erosions appear as focal areas within cortical bone where the normal signal intensity is reduced on T1- and increased on T2-weighted images. When viewed en face they may appear cystic, but when profiled an overlying cortical defect is seen. Erosions often enhance after i.v. Gd-DTPA, implying the presence of inflamed synovium within the defect. Studies of MRI at the hand and wrist in RA have revealed that bony erosions develop very much earlier than had been thought from plain radiography [10, 11, 12]. The exact time to the onset of erosion has not been defined and probably varies between individual patients, but McGonagle et al. [13] found that 18 of 19 patients with symptoms for <1?yr had erosions of the dominant hand on MRI. Our own studies of RA patients with symptoms for =6 months revealed 45% to have carpal MRI erosions at presentation, rising to 74% at 1?yr [14, 15]. This compares with 15% having erosions on X-ray at baseline increasing to 29% at 1?yr. The capitate was the most common site for erosion, consistent with observations by other investigators [16, 17]. Studies of MCP and PIP joints have been less extensive, but suggest that erosions also appear early at these sites [18]. The earliest radiological erosions are frequently seen at metatarsophalangeal joints [19], but unfortunately there are no relevant reports of MRI of the feet in the literature."
amkoffee
Posted
Oh boy Eileen I'm not sure I understood much of anything of the paragraphs that was quite Medical. However I recognized one word that my rheumatologist used quite a bit and that was: synovium.
I'm not convinced that I don't also have PMR. But I'm basing that mostly on the one time that I didn't take my prednisone first thing in the morning and the pain in my arms from my elbow down was horrible. then that pain subsided once I took my prednisone dose. And then there was an incident where I was going to fall out flare. And the pain throughout my whole body was horrible. But it was relieved by upping the dose of prednisone. And of course I responded very quickly to the increased dosage. Maybe it's wishful thinking because with PMR I am more likely to have a remission. There is no remission for ra.
Daniel1143 I guess that's the reason why my Dr said that based on my MRI findings she was going to treat this like RA. But in further conversation I asked her if I have RA and she said yes. So I think her diagnosis was a little soft like you mentioned. Although the report of the MRI clearly states the radiologist opinion of RA. So there you have it pretty wishy-washy, huh!
EileenH amkoffee
Posted
Pred will also help in RA - and some doctors will keep patients on a low dose on its own if there is no sign of joint damage which is quite common in LORA (late onset RA).
I should have done this for you (but some people get a bit iffy about "being talked down to"
: here it is in easier language - ask if there is still something you don't get. I've put each sentence separately to make it easier (I think).
"Plain x-rays aren't a useful investigation in early RA as X-ray images usually remain normal for at least 6–12 months after symptom onset [9].
The first changes due to the disease develop unseen, leaving the clinician to manage the patient according to the degree of joint inflammation while guessing at the amount of underlying damage to the joint. In contrast,
MRI provides a window through which we are able to see how the disease process unfolds from the first time the patient comes to the doctor with symptoms.
In MRI, bony erosions (patches of inflammation) appear as focal areas on the outer layer of bone where the normal signal intensity is reduced or increased using different sorts of images.
Looking at their surface they may look like cysts, but when looked at sideways a defect is seen on the surface of the bone.
Erosions are often easier to see after an infusion of Gd-DTPA, showing there is inflamed synovium within the defect.
Studies of MRI at the hand and wrist in RA have revealed that bony erosions develop very much earlier than had been thought from plain radiography [10, 11, 12]. The exact time of the start of this erosion is not known, it probably varies between individual patients, but McGonagle et al. [13] found that in 18 of 19 patients with symptoms for <1?yr there were such erosions to be seen in an MRI of their dominant hand (hand used most).
Our own studies of RA patients with symptoms for =6 months showed that there were such erosions in the carpal tunnels right from the start in 45% of them, rising to 74% at 1?yr [14, 15].
With x-rays, only 15% had such signs at the start increasing to 29% at 1?yr.
The capitate (the largest bone in the wrist) was the most common site for erosion, as also found by other investigators [16, 17].
There have been fewer studies of MCP (knuckle) and PIP (finger joint nearest to knuckles) joints, but they suggest that erosions also appear early at these sites [18].
The earliest erosions to be seen with x-rays are frequently seen at metatarsophalangeal joints(metatarsals, the small bones in the feet nearest to the toes, often broken by soccer players) [19], but unfortunately there are no relevant reports of MRI of the feet in the literature."
I imagine the report is on the basis of them seeing those erosions it describes - and they know how they usually progress. They could actually see them developing in an MRI before they cause pain.
There may generally be no remission in RA (there is sometimes in younger patients) but they do have lots more drugs that stop the progression of the joint damage and help a lot. Having an RA diagnosis in the USA does seem to mean they can access far more drugs. I think that the people with PMR who are helped by methotrexate probably have the very early stages of RA and very early intervention is known to make a major difference.
I hope this helps you understand it better.
amkoffee EileenH
Posted
A much better read then the other. Thank you for explaining it to me in a way I can understand. I do have a question though. I had an MRI done on my right foot about a year ago and the only thing it showed was OA in a bone near the metatarsal bone on the top of my foot. Was that perhaps a misdiagnoses? Also I was told I had OA in my SI joints. And that was also about a year ago. Well I wish it was all just OA because that doesn't cause damage. I wonder if it was misdiagnosed as well.
Anhaga amkoffee
Posted
Well although RA does a lot more damage that OA, OA is not without serious issues of its own. I've been virtually crippled off and on the past couple of months with my back, and that has been determined (and confirmed several times over the years) as being caused by arthritic changes in my spine. But I concede that I'd rather have OA than the RA which struck my cousin.
EileenH amkoffee
Posted
I don't know to be honest amkoffee - but it might be worth asking, Suppose it all depends how you look at it - there is no treatment at all for OA and it can lead to damaged joints. If you find the right drug, RA can be slowed and even stopped from progressing.
amkoffee Anhaga
Posted
Anhaga amkoffee
Posted
I just stumbled over a research paper which indicates there's now believed to be a definite inflammatory component to osteoarthritis. Guess we can add it to the suite of inflammatory diseases the people on this forum suffer from. And it would also explain why initial dosage of pred (15 mg) eliminated all my pain including OA, as pred isn't a painkiller as such
Anhaga
Posted
https://www.ncbi.nlm.nih.gov/pubmed/23194896
Anhaga amkoffee
Posted
Dr Google says that inflammatory arthritis is usually called rheumatoid arthritis and noninflammatory arthritis is osteoarthritis. I know there are a zillion different kinds of arthritis, but I suspect your doctor is right and it's just a question of terminology.
I hope that you now get the additional treatment which will relieve the ongoing pain you've suffered. Hugs.
EileenH Anhaga
Posted
There are several inflammatory arthritides, RA is just one of them. Arthritisdotorg says
"Inflammatory arthritis is a group of diseases characterized by inflammation of the joints and often other tissues. These include rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, juvenile idiopathic arthritis and systemic lupus erythematosus (lupus) among others."
And it matters which because some respond to a given drug and not to others.
amkoffee EileenH
Posted
Well she did say that she was going to have to rule out lupus which is a Medicare required hoop to jump through. Lupus does not have a blood test does it? Isn't it one of those diseases that you have to rule out everything else and then decide that it's lupus?
EileenH amkoffee
Posted
There are blood tests that draw a picture but you're right in that there is no single 100% certain test and some doctors won't say lupus unless they get certain results. Now where have we heard that before!!!! To some extent the drugs are similar but there are some that work in lupus that work less well in RA. Some of the symptoms are quite clear - if you have them. But they often are a bit tardy about appearing.
The LupusUK forum on HealthUnlocked is very good - and they have info packs and stuff. Quite a lot of people from the US on it.