Is it RA?

[DrJJ]

Happy New Year all! I've recently been diagnosed with RA (I think!) and am waiting to go on some initial medication (methotrexate and hydroxychloroquine) at the end of the month. But, I'm really not sure about the diagnosis...

I initially went to the GP because I had a finger that wouldn't bend (it does if I really bend slowly and pull hard), but it wasn't that painful. The GP took some blood and my anti-CCP levels were a bit high but everything else was normal. So he referred me to the consultant, who asked tons of questions and said my finger was trigger finger but he was also worried about my foot as I'd had morton's neuroma in it a while ago and it was still a bit painful. The next step was X-rays and ultrasound examination. At the ultrasound the consultant was also present and they couldn't find anything wrong with my finger (other than it couldn't bend, but the tendons and joints all looked ok) but as soon as they looked at my foot the consultant said 'that's RA, we'll put you on the meds' and then pretty much rushed off to his next appointment. I asked if I would have another appointment with him to discuss the results but he seemed to suggest that I would only see the nurse next to get the medication.

So I am a bit confused as my finger still won't bend and no one seems any the wiser as to why that might be. And I don't feel like I have a big joint problem so a diagnosis of RA seems a bit over the top..? I know that the medication can be quite heavy so I don't really want to go on major medication if i don't need it, but on the other hand if they have caught something early then it is a good thing.

I guess I'd like to know if this is a normal experience or do I need to try and get another appointment with the consultant to try and get a few more answers?

(I'm also really interested in how diet might affect all this, but that might be another post!)

[keeta]

Welcome to our little club.i had pain in hands and feet for years .being told it was wear and tear.my hand was like a claw and I just got used to it .If I caught it .It was unbearable.but it had to get a lot worse before the doctor sent me back to consultants .who did all tests as you did.but showed so much inflamatory. Once on methetreate my claw opened like a miracle.even tho I am having problems now associated with the injection. It works. Everyone can tell a different story tho.good luck love.please come back and tell us how you get on.

[helixhelix]

It is all a bit odd to start with, and can understand that you feel a bit railroaded right now. A couple of bits of my experience that might help. First off my nurse is a specialist rheumatology nurse and can answer all sorts of questions, so if you've got an appointment booked then talk things through with him/her. Also, ask your GP for a copy of the letter from the rheumatologist as that should set things out.

Under ultrasound the inflammation and erosion of RA can be very distinctive, so it makes sense to me that they can take a quick look and be pretty certain. And if you have a raised anti-CCP although that's not conclusive it is another big indicator. Do you have normal inflammation levels?

Early treatment is always said to give the best outcomes for RA, but do remember that if you don't like it you can always stop! It's always your choices what treatment you accept.

As for diet, I have altered my diet to more fish, fruit & veg and little meat & dairy - and no processed foods or rubbish. Personally I think diet alone can only help in very rare cases, but for me it has helped me tolerate the drugs. I have no side effects from them at all now. Exercise is equally important.

Like Keeta when I was finally diagnosed things had got bad, and I really never thought that I'd get back my mobility as I could hardly walk by then. But I did and walk miles each day now!

[stbernhard]

It is hard to say if you may have RA or not from what you write. Probably best to speak to a medical professional again. You can also phone the NRAS helpline, they are more qualified to give advice than many of us. Good luck and fingers crossed it's not RA!

[Hidden]

I agree with Helix - the tell tale signs of RA are quite specific if viewed by ultrasound and X-Ray so the rheumatologist must be pretty familiar with them and have identified them clearly in your feet. They would only put you on Methotrexate if sufficiently certain.

I think that RA can be relatively painless in the early stages for some people. I had severe joint pain with mine but also had a finger I couldn't bend at all and was put on methotrexate and then later on Hydroxy with it and took these for two years. I came off several times and it never returned in my fingers but it came back in my knees and wrists and toes.

But I eventually had bad allergic reactions to these and other drugs so had to stop and the RA symptoms have so far stayed away. However I do still have some of the systemic symptoms and my urinary tract and kidneys are now not so good and being investigated for other connective tissue diseases.

I am anti-CCP negative so my new rheumy is looking for other types of inflammatory disease. I think the methotrexate and Hydroxy chased off the RA pretty effectively. My finger/ hands has no sign of erosions and I have no eroded joints at all - fingers fully flexible again within a year of taking methotrexate. I'm not saying that it will be the same for you but it may well be that the rheumatologist could see that you had RA from the ultrasound. You have the opportunity to prevent eroded joints occurring now although I can see why you might be wary of taking such strong medications on this basis alone. However they don't dish out these kind of drugs lightly.

[Bob11235]

That sounds similar to my diagnosis. I had an index finger and large finger on each hand that we're swollen as well as neuropathy in my feet and hands. The anti-ccp was three times the acceptable limit and I was diagnosed with RA. I started methotrexate and prednisone and got some relief. Eight months later, the RA or whatever seems to be progressing slowly.

[DrJJ]

Thanks for all the replies. It’s great to hear that your hands improved after treatment keeta and Bob11235. It’s also reassuring to hear that the rheumatologist could make a quick decision (although I agree could be right about right about the diagnosis, I think there was better way of letting me know). I will definitely ask the GP for a copy of the letter as it might add a bit of clarity.

Perhaps the specialist nurse will be able to answer a few questions - I've still got a few weeks to wait until the appointment. My mum had a ‘joint problem’ when she was about my age, but it was never diagnosed as anything in particular (RA was ruled out among other things) so if it is something similar then it would be great to avoid the pain she went through.

Thanks for helping me feel a bit less alone with it all!

[Fgrant]

I dont know if this will help you. I had the same issue of my fingers not bending and pain all day with little help from meds. I recently had my vitamin d.levels.checked.and once.i had been on the vitamin d..my pain nearly went away and.I am not on any RA meds

[Kathyfitz12]

I was initially diagnosed with sero positive palindromic R A after consulting my GP with trigger finger. I was prescribed Mtx & took it very successfully for years until I suddenly reacted very badly to it. I'm now on Arava ( Leflunomide) & apart from weight loss I,m settled on it very well.

I have minimal joint damage & very little pain these days & my trigger finger just disappeared. My GP (who admits she knows very little about RA) is always surprised at this as my blood tests constantly show active disease.

I started on dmards as son as I was diagnosed & my consultant ( not the original doctor) says the reason I am lucky enough not to have much damage is because I was put on the right medication so early.

As for seeing only the Rheumatology nurse, I have found they are excellent. They have an in depth knowledge of their speciality & will probably have seen patients with a similar diagnosis to yours & they will monitor you very closely. I was once late with my bloods due to being delayed abroad & my rheumy nurse was on it straight away & emailed me to get the tests done ASAP.

If you do start on Mtx....remember all the people on this site who deal with it very well & try to put to the back of your mind those who cannot take it. For me it was a magic pill for about 9 years.....OK it did go wrong for me eventually......but it stopped joint damage & here I am now serried in Arava and 99% pain free.

Good luck and Happy New Year to you too!

Kathy

[DrJJ]

Vitamin D? That's an interesting thought. I'll check with the doc to see if that has been tested or not.

Thanks for the positive story about Mtx Kathy. It's good to hear that you are pain free

There's so much to think and worry about at the moment - its all so new. I'll have to come up with a good list of questions for the rheumatology nurse...