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Differential diagnosis - definitive for RA

Just received a copy of the letter my Rheumatologist sent to my GP following my recent clinic appointment.

During my clinic appointment I showed her pictures of my sore, swollen hands/wrists and left foot (by my little toe) which I thought were symptoms of my RA. She told me I needed to be referred to the combined dermatology/rheumatology clinic which she holds because she suspects (and said a complicated medical term that I did not pick up on at the time) that the photos show a rash not RA flare.

During my clinic visit she said she was still largely convinced that I do have RA (RH factor of 107.5 plus family history) but ordered lots of extra blood tests as she feels there is something else going on.

The letter confirmed "CCP of >340 - strongly positive" so Im assuming this, along with original RF, confirms RA without a doubt. But in the letter she then says the dermatology referral is due to (and gave the long word she used in appointment) erythromelalgia. I have therefore started my new investigation into this condition. Having looked at a few pictures online I can understand why she is querying this.

Dam it - I was just starting to think that the photos just showed a rash and that the rash could have been allergic reaction to the Sulphasalazine... now it appears it might be something more serious :-( ..... to think I was so fit and healthy 18 months ago and now feel like I belong on the scrap heap

6 Replies

it would appear that this can appear as a primary or secondary condition eg primary on its own or secondar eg to diabetes oe scondary to ra? it can be treated with nifedipine


Thanks, think on my limited research so far it may b secondary to ra in my case. I have dermatology appointment on 22 april so not long to wait before I get some answers. I would b a little worried about using nifedipine as it suggests its used for high blood pressure when mine is already low so dont think lowering it further would b good.

I will just have to wait and c what they say.

Thanks again


sorry should say secondary or primary. computer lag and finger lag??!!


Nifedipine is indeed used for blood pressure but also raynuards and your condition.

Other drugs with multiple uses are eg propanlol( low dose anxiety,) higher dose blood pressure.amitrypyline high dose depression. low dose pain( nerve pain)

suspect nifedipine would be sub therapeutic blood pressure dose if used in your case. best wishes xx


It is interesting u mentioning amitytrypiline as I was prescribed them to help with pain at night and to get back to sleep. I dont use them very often but when my wrist flared I did. Mayb this is y the flare disappeared/eased by morning.

Thank you for that insight. Certainly food for thought.


I don't know anything about erythromelalgia but I know how it feels to compare & contrast 'then' - the recent past - to 'now'! A lot of snow-shovelling going on round here lately but nobody expects me to join in, though I can do a bit. Some would be grateful I suppose but I love being physically active. Preferably a long walk or swim but any job of work will do. It's like part of my identity has been surgically removed but I guess we just have to grow a new & even stronger one!

I hope you get the answers you need & that your condition is soon well under control.

Luce x


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