Hi - After 4 years with RA, I was driving to visit a relative one beautiful sunny day when suddenly I got this god-awful pain in my wrist.  I pulled over and took all I had (basically Celebrex & Tylenol).  Didn't help much.  Eventually down the road (a month later when I saw my rheumatologist) he said, since your inflammation level is low, this must be osteoarthritis.  Further down the road I got xrays & MRI (not the first - this is the wrist where it all started.)  The end of my lower arm bones and also my wrist (carpal) bones were full of cysts.  I had had bone edema when diagnosed.  Now the bones were in more serious damage.  So RA damage can lead also to OA problems.  How is your inflammation? 

    It may sound weird, but sometimes Tylenol helps pain more than Celebrex (depends on whether it's inflammation or not).  When both of those fail, I have Percocet left from ankle surgery and carpal tunnel surgery (other wrist) that I take when I can't sleep, though I won't take Percocet continuously. 

    If it's an all-over flare, it probably is the RA.  But another possibility is fibromyalgia - your nervous system can become so stressed from the pain you're dealing with that in essence you develop nerve pain - the neurons are overstimulated and just keep firing.  Sometimes a pain killer will stop the cycle, but sometimes it backfires.  There are a few medicines for fibro (FM) now, if that is the problem.  Sometimes for a diagnosis of FM, doctors (does not have to be a rheum.) will check 18 'tender points' and if you have a certain number, it's FM.  But even that may be too rule-bound.  Pain is pain.  Is is the same kind of pain you've had before, or is it different, somehow? Does activity make it worse, or better?

     Just some suggestions to think about.

     Re: diet.  For me personally, dairy doesn't make a difference, but green peppers and red meat really do.  Studies have shown that avoiding meat in general can also reduce pain, and when I'm in the most pain, I'll go veggie for a week  (salads, beans & veggie soup, lentils & rice, whatever works for you). If you need more than veggies, and like fish, then eat fish.... Fish is better than meat (omega-3s).

annicam

9/30/09 10:52am

What I have learned after suffering with Rheumatoid arthritis and Fibromyalgia for 20 years is that all rheumatic diseases are nasty, nasty diseases.  The Rheumatologists do what they can but they tend to focus on halting the progression of deformity of the joints.  Of course, that is important but the day to day pain has the biggest impact on my overall happiness.  There are more and more treatments, especially the new "biologics" for arthritis now but these treatments don't work ideally for every person. I have virtually tried every med available.  I thank God for my family doctor and her compassion, who prescribed a pain patch (brand name is Duragesic) for me when my rheumatologist didn't want to talk about pain control.  This patch has been a life-saver for me.  It takes the top one-third to two-thirds of pain off my overall pain level. The odd time when I forget to change my patch and my pain rears up again, I realize how bad it can be and how grateful I am for my family doc!  With the patch, I can feel much more positive and deal with the stressors of life.  I really believe that this medication has been the most useful medication in the treatment of my RA and FM.

Ellen Galo

9/30/09 11:14am

having passed the 5-year mark, I shudder to think about 20 years ... I agree with your remark about the focus on avoiding joint deformity (my rheumy says, 'don't talk to me about your other arthritis pain!) and my regular doctor has also offered me more pain meds if I need it - I'm still using leftover pills from surgery when I need them, but I told him I'll take him up on that if and when I need to (i.e., when my pills runout!)  I'm actually starting to use them more....

    And - I had some major joint destruction within 3 months, before I got to the rheumatologist, even though I was diagnosed pretty quick.  Remicade, and then Enbrel beat it back for a while, but now the combination of RA & OA on top of that means I'm headed for more surgery in January...

    Just curious, do you find your RA & FM flare together, or opposite?  Lene has mentioned the Enbrel made her FM much worse, and that seems to be coming true for me as well.  Always looking for the balance.  There's pain, and there's Pain and there's P_A_I_N which negates anything else for the duration.

    Good to hear from you!