Bursitis and Ra

[mohikan22]

Ok. Fellow sufferers. ..having Bursitis in my shoulder joint atm...about week 2.5 atm.have had a cortisone inj last almost a week ago..seems no change..However that said..I'm only on mtx folic acid etopan and prednisone (7.5mg) a day with 3x a day of gebapentin. Other than its aggrevating and quite frankly f@#$€*, ng me off. .....could MY RA of kicked in in the same place?????

[helixhelix]

I always get a bit confused when people say they have bursitis in a joint and they also happen to have RA, as what's the difference between an inflammed synovial joint due to RA and an inflammed synovial joint that is put down to bursitis?

Ok RA is supposed to be symmetrical, but the last time one of my elbows went AWOL my rheumy said that the RA had caused bursitis in that joint....

And yes tennis elbow / housemaid's knee and so on are bursitis due to excessive use, but chance would be a fine thing to overuse a joint if you happened to have active RA!

Not v helpful to your question I'm afraid, But interested to hear whether others have been told there's a difference.

[Hidden in reply to helixhelix]

Hi.. I found it very confusing too and Im not a doc but this is what I think happens.

The "bursa" is a sac with a synovial membrane containing fluid that has synovial cells inside it. Its purpose is to cushion and its found in tissue or surrounds the joints to help tendons etc glide smoothly over bone. It can also cushion something that needs protecting ie the prepatellar bursa on top of the patella. When the sac is inflammed its called "bursitis" and it can be set off when its constantly used or when it becomes inflamed and caught (impingement), but in our case it can be attacked by inflammatory diseases such as AS, PsA or RA.

On the other hand, with "synovial joints", the whole joint is encapsulated with the same membrane that the bursa has, but it has 2 other layers as well. Inside the membrane is the same fluid containing synovial cells but its purpose is to lubricate the whole joint. When the synovial membrane surrounding the whole joint is inflammed, it produces more fluid so it swells and becomes hot and is then called "synovitis".

So in short... The whole joint is involved in synovitis whereas in bursitis, just the sac is involved. Both can be red, swollen and painful but it depends whether its the whole joint or just the sac is inflamed to give a diagnosis of either synovitis or bursitis. Its hard to tell if RA is responsible for either of them without sending the fluid off for testing and then there are certain cells that RA gives off that they will find in an RA patient vs non RA.

I may be wrong with this so its best to ask your doc or research it but thats the way I understand it.

[Hidden]

Im with helix on this one. For the past year my ra has been inadequately treated and the whole time I've had pain in one or both shoulders, elbows, hips etc etc. For instance I can't distinguish the elbow pain at all from the pain felt when I suffered recurring "tennis elbow" before diagnosis with ra. No amount of heat, massage, hydrotherapy or strengthening exercises helped either because what was needed was better drug therapy for my ra. A week after my first injection of methotrexate the dreadful shoulder pain diminished along with the tennis elbow. Has your esr increased? That could also indicate your ra has flared. Maybe a drug change is needed? Hope you get it sorted soon. x

[mohikan22 in reply to Hidden]

Hi thx for the reply. As I said up there I'm currently on next to no "useful meds" as my rhuemy wants to"see" an inflammation via a scan.so I suffer he sees. However I've have this "buritis" diagnosed before and its exactly the same and inj as before.yet not gone away.so I wondered if it was ra kicking in or the bursitis still giving grief because my meds have changed from before.....I expect flares atm until I can get bad enough for a scan in an "easy to see blood flow" area...just my body isn't helping there lol.

[Hidden in reply to mohikan22]

Mohikan Does the doc want to do a CT or MRI scan on a specific area or are you talking a whole body nuclear med scan? My NM scan lit up in a load of places so its a good tool to prove inflammation... I hope you get one and it shows it all too.

[mohikan22 in reply to Hidden]

He didn't say but as this will be Scottish NHS...I'm guessing local ultrasound lol

[Hidden in reply to mohikan22]

Ultrasound is a good test for showing musculoskeletal problems including bursitis/impingement, synovitis, arthritis and cuff tears so its well worthwhile when you have pain. Let us know how it goes.

[Hidden]

Hi Mohikan, I am sorry the injection didnt work for you, I had lots of ones that worked in the shoulder but when the time it worked for got shorter and shorter, they operated.

Yes, as I said to Helix above, its my understanding (Im not a doc) that your RA could be responsible but Im not sure you can know if its RA unless the fluid is sampled and sent away for analysing. Unfortunately they rarely do that in the shoulder unless the think its infected.

It may be worth asking if you can temporarily increase your prednisone. Good luck with it, let us know how you go.

[Hidden]

I have bursitis of the hip and my rheumy said it was due to PsA. Perhaps the confusion arises from the fact that the very same thing, the same type of inflammation, can also happen without inflammatory arthritis.

Similarly I get tendonitis .... another condition that occurs without underlying disease I believe, but when the underlying disease is present then it seems that any joint 'itis' is likely to be connected to the disease.

[Gillian1163]

Hi I've just been diagnose with bursitis in my knee which is definitely not from excessive use. I've had RA for over 20 years which is currently relatively well controlled with Rituximab. The GP suggested that the bursitis was a "perk" of RA

[mohikan22]

hi all again, bit of a update.. i had the injection...but alas no resolve. my RA nurse has said its nothing you just need some physio... right... ok.. now im 6ish weeks along and its STILL with me everyday in different pain/movement levels.... added onto this im now also on 17.5mg prednisone daliy doing the usual 2.5mg drop a week until i get to 7.5 when i next see the rhumy nurse... just feel like im being bumped along until my steroid level is low enough,