Tennis elbow knee pain and remission

[antibes]

I have tennis elbow in my left elbow and a small amount of synovial fluid and my rheumY has suggested a cortisone injection. Has anyone has this ? I also have wear and tear in my cartilage in my knee but my rheumY says is not ra related. , I thought ra ate through the cariltilidge. He also says I am in chemical remission apart from awful elbow pain and knee pain and a few twinges i very rarely take the declofenac for pain relief Is this what chemical remission is ? I am on mtx 15 and Plaquenil 2 a day. And folic acid. Can anyone shed some light please I thought chemical remission meant pain free all the time ?? Xx

[helixhelix]

Hmmm, I think remission is another of those words that mean one thing to a rheumy, and another to us! My idea of remission is just like yours - no pain, no swellings and basically totally NORMAL. But I have a feeling that remission for a medical person, who's on the other side of this, just means that there is only low disease activity that is merely chugging along very slowly and not doing great damage. I had one conversation with the rheumy nurse along the lines of "well if your DAS gets below 2.5 you'll be in remission", which is entirely possible to get to even with several swollen/tender joints.....

And apparently OA damage to cartilage looks a bit different to RA damage....but both hurt! Polly

[Hidden]

Well I thought so too Antibes - its very confusing. I went to see a rheumy 3 weeks ago thinking he would say I was in drug induced remission but instead he said I still had about 30% active disease. He judged this only be examining my hands and taking my word that nothing else hurt apart from my back - which he didn't examine but says would probably be wear and tear and not RA. He said this 30% was based on my ESR still being at 26 (it was at 62 when I was diagnosed). But I've read that 26 could well be normal range for a woman of 50.

I have currently quite a lot of aches and don't feel that great actually but I am not sure if this is OA or RA. I take same drugs as you but had a recent raise to my Metoject (injectable MTX) to 17.5 and less Hydroxichloraquine now than you at 200mg per day although he said I could move up to 300 if I wanted. It was all quite scientifically measured but I came away feeling less confident about things than when I had gone in for some reason - probably the lack of discussion.

We have to trust these consultants I suppose but some seem to base everything on pain levels and others on blood results or visible signs. I prefer the more scientific way because I find it very hard to measure pain and don't really trust myself. On the other hand I do like them to be very thorough otherwise I'm left with more questions than answers. Maybe some x-rays would help us to know what is OA and what is RA more? Have you had some done?

[antibes in reply to Hidden]

I had an MRI on both the knee and elbow this is when he said wear and tear of the knee cartilage which I don't get as I thought ra attacked the cartilage like you whilst I think themeds are goods I don't think thecrheumys explain things and we all seem to want answers and to be ompetlypain free I am going for a second opinion with an elbow specialist I've used him before when I broke my wrist and he deals with ra in th elbow I'm really interested in what he says I'm going armed with my MRI so I'll update you xx

[Hidden]

may be remission apart from elbow? im not in remision at moment and feel like sawing arm off at elbow as at moment it is the most painful joint x

[antibes in reply to Hidden]

I'm with you there it is so painful x

[Hidden]

I last saw my rheumy back in September and he stated that as I wasn't suffering too much pain and the sulfa and hydroxy seemed to be keeping everything in some sort of control, that I was in drug induced remission. I thought brilliant, but unfortunately, although I'm now on 6 sulfa and 2 hydroxyl I'm still having to take 2 naproxen each day to keep going, so I think his understanding of remission is certainly different from mine. He told me he didn't need to see me for 12 months but I'm now thinking I need to see him or more probably my rheumy nurse.

Carolyn

[antibes in reply to Hidden]

I think they all seem to give us meds and then say get on with it I appreciate its a lot of pain in different places and they probably get a bit fed up but they chose ra . I'm always looking for answers and continue to try and do everything to help myself any tips I'll let you know !!! Good luck with seeing the rheumY x

[earthwitch]

Seems there is some disagreement about the use of steroid shots for tennis elbow with this article saying they are a no-no (thanks Molly from the kickAS group for the info)

medicinenet.com/script/main...

Steroid Shots for Tennis Elbow Miss the Mark: Study

"For people with tennis elbow -- a painful condition related to overuse of the tendon in the elbow -- more bad news emerged from the study: Combining physical therapy with a steroid shot was of no benefit over the long-term either. (more...)

""We discourage patients from cortisone," Rokito said. "While it may give them a very short-term benefit, overall it doesn't help."

Tennis elbow is a repetitive activity injury, Rokito said. "The best thing for patients to do is rest from the offending activity.""

[earthwitch]

Do you have RA or spondyloarthritis? If that was spondy, then having elbow and knee pain still definitely wouldn't be considered remission as those are active areas for enthesitis.

[Hidden]

I am fairly sure they are active disease places for RA too? On the other hand you can also get Osteoarthritis in both which is why I asked about X-rays (and MRIs)

[earthwitch in reply to Hidden]

Yes, but with different areas of the joint being affected. As I understand it, RA is primarily about synovitis (so thats usually the surfaces right inside the joint), OA is when the joint gets rather "dry" and bone rubs on bone, and spondyloarthritis is right at the point where tendons join onto bone - so spondyloarthritis produces much the same result as tendonitis, only just in the part of the tendon that is right up against the bone (the entheses). Sorry, my descriptions are rather broad, but thats just a very brief kind of summary

[nanypat]

ANTIBES I Have had the Cortizone injection in my elbow which in my case[ Bursitis] was very sucessful and has never returned .I also have OA in my knees and have just been diagnosed wth a BAKERS CYST as well, which is located behind the knee cap,i get an awful lot of pain in lower leg and foot making walking very painful .Has anyone else had this probem i would like to know more about it PLEASE.

Pat

[Hidden]

I've had injections for tennis elbow which helped in the short term but I ended up having surgery which has helped. I've also had golfers elbow in the other arm & had surgery for that. I've not got tennis elbow in that one which surgery was suggested but in the scheme of things that is the lesser pain compared to my other joints! It's suggested that it clears up spontaneously in the end but I've had mine for several years now!

[Hidden]

To my suspicious little mind there seems to be something going on that inclines some Rheumatologists to take the narrowest possible view of disease activity. I'm thinking of how one can have pain all over the show but unless there is obvious swelling some Rheumys show not the slightest interest in examining the painful areas or having them x-rayed etc. Similarly a lot of OA is dismissed as wear and tear but without imaging & careful interpretation I don't see how they can be so sure.

Is the DAS criteria partly to blame I wonder? As far as I remember it does not take a blind bit of notice of damage done. I think cost-cutting must be partly to blame - on the grounds that it usually is - perhaps recognising all the damage done to joints as grounds for anti-tnf therapy would open the floodgates!

I think the question of whether your cartilage has been eroded by RA or not is important because if 'remission' means anything at all it is surely that your joints are no longer in danger?? I'm sure that if any of us were told that we could rest assured that our disease was no longer attacking joints then putting up with even quite high levels of pain & stiffness would be a lot easier.

I've got a DAS target to meet but in itself it's meaningless I feel. My Rheumy does agree that most of the damage done to my joints occurred before diagnosis. And at the time my DAS score, had I had one, would almost certainly have been low.

Hopefully your Rheumy's definition of chemical remission takes account of how safe your joints are but if I were you I'd press him on this issue. I guess no doctor can give you 100% assurance that no further damage will occur but it would be good to know how confident he is that that is the case.

Luce xx

[earthwitch in reply to Hidden]

great answer, and yes, DAS scores really don't tell the whole story. DAS scores are also totally irrelevant if its spondyloarthritis, and to my also suspicious mind, I don't think rheumatologists in the UK are giving enough people a spondy diagnosis - preferring to keep people under the "seronegative arthritis" of "inflammatory arthritis" banner and feeding them up with cheap DMARDs that don't actually do much good. Measurement of disease activity in spondyloarthritis has several different scales including metrology (BASMI - measuring flexibility of joints), functional index (how well you can manage daily tasks, eg BASFI) and disease activity scoring (BASDAI or Dougados index, etc) Mind you, I haven't heard of anyone in the UK who actually regularly has all those measurements done, (except for folk under some of the Bath Rheumatology services where the measurement scales came from originally, or use of BASDAI if you are on anti-tnfs).

[antibes in reply to Hidden]

Thank you Luce

I agree totally with your comments and would like a definitive answer as I want to minimise any damage I' will press him again on my next visit thank you great feed back xx

[antibes in reply to Hidden]

Thank you Luce

You put it all so eloquently ,I think I'll write down your comments re the knee joint annd reverberate them to my rheumY as minimising the damage of the joints is what we all want to stop . re the pain you make another great point we would all tolerate it if we were not so fearful of the damage

Thank you. Monique xx

[Hidden]

Hi, I have suffered tennis elbow on and off over the years and have had steroid injections into the joint but can't say they really helped. Mine last kicked off just before Christmas when I joined a new gym and was using an elliptical trainer. The repetitive skiing action was straining my elbow so I just stopped using the handles and it settled down in about 6wks. The rheumy nurse also suggested ibuprofen gel to me which I used a couple of times.

Paula x

[antibes in reply to Hidden]

Thank you xx

[Hidden]

I had tennis elbow about 4 years ago. I had physio for it and she would massage my arm with something like a mini rolling pin and iron out the knots she said were huge. I would get my hubby to do this too between physio sessions and it finally cleared up. When RA started in my wrists and hands it felt exactly the same so I assumed it as RSI as I had been stitching for a project 24/7. A locum GP then told me it was Carpal Tunnel. I asked why it had started in my knees too and he said that was my overweight frame and cartilage problems. I left feeling really stupid for having allowed myself to get so fat and carried on bumping up and down steps sideways like a crab for a few weeks with splints in wrists too until my feet started burning up as well. Then a GP friend came by and said she thought I had better go back as RSI didn't really seem to sum up what was going on!!

I wonder how they can possibly know if something's wear and tear or inflammatory arthritis if they don't examine or take x-rays or MRI scans really? I think the economic situation is must be hampering proper diagnoses and meaning that rheumatologists are relying heavily on guesswork! X

[antibes]

I don't know how they differentiate between wear and tear and to be honest even though I had the MRI I feel I should have asked him how he knew but I felt a bit rude especially as in the past he told me I want perfection which I answered yes I have one body and want it to be the best it can be. However I'm getting a second opinion re elbow and will write a list of questions re knee to rheumY I don't want any joint damage ! Xx