Rheumatoid Arthritis Support Group
Rheumatoid arthritis is a chronic, inflammatory, multisystem, autoimmune disorder. It is a disabling and painful condition which can lead to substantial loss of mobility due to pain and joint destruction. The disease is also systemic in that it often also affects many extra-articular tissues throughout the body including the skin, blood vessels, heart, lungs, and...
Good morning My name is CHris I am a 48 yr old male history of OA in neck back hips and knees for several years . Approx 2 to 3 years ago I began to have pain in my hands after a few moments of using them . The pain would be very intense and last maybe 2 or 3 minutes and I could continue to do whatever pain free. My dr noted that my hands were swollen and red . During this time I had esr and ccp ( not sure names are correct ) blood tests become abnormal only to return to normal 3 months later on blood test . they have gone up and down a few times . Approx a year ago I began to get morning stiffness in my right hand middle and ring fingers. Shortly there after hard lumps under the skin on these fingers on the pip joint began to appear . More blood test this time with rf being tested all came back normal . Xrays of hands were taken and no arthritis was found . now left hand ring and middle fingers are sore and stiff . Both hands are sore red warm and pip joints are swollen. Hard lumps are still very present . Had first appointment with rhumo 3 weeks ago . Started back on meloxicam for Oa in hips and back . Mild relief of symptoms. Dr has stated that at the next appointment if hands are not feeling better with the meloxicam I am to start steroids as it is suspicious of ser*** ra( not sure the exact name but its ra without blood work being out of normal . First question my appointment is March 14 and was told if the oa was not better to call and they would give me a different nsaid . There is no relief on my hands from meds . Should I call dr and have them change the oa meds or do they take more than 3 weeks to be effective ? Should I call and request the roids now vs next month ? I have read that the earlier the treatment the better ? Is it normal to have bloodwork fluctuate neg to pos and back again ?If xrays show no arthritus but there are very visable lumps and swelling on pip joints noted by myself my primary and rhumo what could it be . When my hands are stiff ( when I first wake up or if I sit around not using my hands ) sometimes my knuckles on my fingers feel as if they need to be cracked . Almost as if there is a pressure in the knuckle itself . Does this sound normal . My example is not the best way to describe it as it is a weird pain in knuckles hard to explain . My grip on my right hand especially feels as if it has changed . Not dramatically but it feels different . Well any info would help I appreciate it .
The word you are thinking of above is seronegative RA -- when the RF and antiCCP tests are normal/negative.
For the ESR and CRP - those are general tests that may be elevated when something active is going on somewhere in the body - like inflammation or infection. They are not just seen in RA. Those can go up and down depending on whether or not you have active inflammation going on. Sometimes they can be used to help in the diagnosis and sometimes they are used to help guide / assess treatment success. My rheum does not use them regularly with my follow-up labs, only when I first presented and when I recently returned after being off my RA meds for about 8 months and needed to restart. And I am seronegative.
The small joint involvement is typical for RA - mine started in both my middle finger PIP joints. I tried high dose naprosyn for about a month and when that did not help, I went on prednisone (all in all for a total of a year with the slow taper), then added methotrexate and humira. After my little break off meds (since I wasn't sure if maybe I had something else since my mild symptoms seemed to not be responding to these big meds), I recently restarted MTX and humira.
Everyone is different in their presentation. It sounds like your rheum is working with you and it is great he asked you to contact if you want to come back sooner. A lot of people on here have stories about difficulty getting in to see a rheum at all.
I would keep a good diary of your symptoms and get back in touch with your rheum. Read about RA treatment to see what some options may be discussed. Prednisone is not a treatment other than providing quick relief sometimes of pain or flares, and can be used to help diagnose RA (which usually responds to pred). If you have RA, you should be on a DMARD and a biologic to best get control and hopefully prevent permanent damage. I have very mild symptoms, and have seroneg RA, but I am doing MTX and humira to prevent damage in addition to hopefully controlling my pain and stiffness.
Good luck and keep us all posted on your next rheum visit.
Thank you for your reply . Just as a point I miss spoke before when I said crp . I was thinking it was anticrp . When I talked to my it was the anticcp because it is that , that only goes high with ra inflammation correct. My primary has tried to get me to see a rhumo since the lumps started but he had told me that it was more than likely my OA. 2.5 years ago when the hands started hurting he said it was probably oa and that was the first time the anticcp was elevated . I remember him explaining that it was an indication of arthritis inflammation. Pryor to my last visit with primary I was looking up my bloodwork and found that the anticcp was arthritis marker but ra instead of oa . I let him send me to rhumo and had first visit . Sorry brain is frazzled grandkids are here so million things . Thanks again
From what you're saying, it sounds to be like the rheumatologist is focusing on OA, rather than RA. When you see him next, ask him about treatments for RA. NSAIDS can relieve inflammation, which is basically the same with steroids, but that's not addressing RA. Sero-negative RA is very common, and elevated anti-ccp should be an indication that there's more than OA going on.
Also, if the bumps on your fingers (are they on the joints, between them?) weren't revealed by x-ray, then I would think they could very well be RA nodules. OA calcifications would should show up. Soft-tissue imaging, such as MRI or CT scan might reveal more, if it's an option.
Good luck.
It's so tiring to have to try so hard to get diagnosis correct.
When the rhuematologist is not sure it gets you second guessing yourself
Everyone presents differently with this disease. Hope your journey starts to go better. I am also having a terrible time getting the appropriate treatment too. And I have positive RF factor of 89. Doc really wants to see CCP positive or one of the other tests or see some damage
I don't want to wait for more damage and most times when I go in he dosent see swelling in my finger s or toes even though they hurt so much. However I have damage to my cervical spine. And idk how I will be treated at my next visit. ?
Keep us posted! Hope you are feeling better!
Interested to know if the doc will still say OA is the cause. ?
Idk the answers either. But I try to investigate all these things. Correct me if I'm wrong but a positive CCP.(anti-cyclic citrullinated peptide) is actually sero- positive RA ? Even if it was high and then low back and forth.
Check it out. The joints in your hips and neck can be effected especially if you have RA left untreated. ?
Let's figure this out. Try to get well ? Or somewhat better.
I have had cervical surgery and I am loaded with debilitation in my hips, lower back and of course the good ole neck :). I am sero positive RA but the rheumatologist tells me that the biologics and dmard treatments over the years have not positively affected my back, hips and neck. i don't need to hear that, I already KNOW that :) Though I believe treatment has helped my hands, wrists, ankles and feet. i just think of myself as OA and RA with treat to target whatever for my RA. I'm not feeling the glow about treatment lately anyway. But I don't want to be a debbie downer, with you. sleuth on. If you get temporarily "cured" with the burst of prednisone bridge planned for mid march, that will give the rheumatologist some answers, also.
welcome again.
depot