Saturday, January 12, 2013

Sunday, July 20, 2008 hopeful asks

Q: Is it necessry to have rheumatoid factors to have a definitive diagnosis of rheumatoid arthritis?

After being treated for a long-term injury & surgery in left knee, I was diagnosed with osteoarthritis.  Years later the same diagnosis for the right knee followed (overuse due to left knee).  Surgery for severe bursitis/nerve damage in left shoulder followed a couple 10 years later.  I also experienced inflammation in the breast-bone and was unable to take deep breaths or lift without pain.  The next stage started with right hand pain - finger and thumb joint pain and 'osteo' lumps from the knuckles, weakness in the wrists, gripping pain through the mid back (tendons compressed according to a chiropractor), inflammed wrist tendon.  Now, the left hand and wrist are similarily impacted.  Overall general weakness (dropping things, weak grip) in both hands.

 

At all stages, I was advised that this is osteoarthritis as I don't have rheumatoid factors showing in blood work.  As the arthritis appears to be symmetrical and impacts in much the same way, I was wondering if either osteo or rhuematoid would be applicable.  Is there another diagnosis which would be possible or likey based on symptoms?

 

Otherwise, generally in good health, no fever.  Alternate suggestions for pain meds also welcome as aspirin raises my blood pressure, long term Tylenol not recommended due to effects on liver.  Have been taking Glucosamine, Chondroitin, MSM for years

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Answers (1)
Lene Andersen, Health Guide
7/21/08 12:22pm

RA can be tricky to diagnose - symptoms come and go, bloodwork wobbles up and down and at times, symptoms can mimic other conditions and if you are older, the tendency can be to diagnose osteo instead of RA. However, from a layperson's point of view, your symptoms sound like they could fit both kinds of arthritis. As well, it is quite possible to have rheumatoid arthritis without testing positive in your bloodwork -many RA patients have a negative RA factor (myself included). However, some doctors prefer having numbers show up on lab tests before they're comfortable making a diagnosis. I would recommend that you find another rheumatologist for a second opinion. I'm a big fan of trusting your instincts and if you feel that a diagnosis of osteo is not giving you the treatment that you need, keep trying. Doctors are people, too and sometimes, you have to meet with several before you find one that works for you.

 

In terms of pain meds, I'm leery of recommending anything specific if you have additional medical issues that may be affected by painkillers. Over-the-counter ibuprofen may help and there are a number of prescription anti-inflammatories that may work for you. However, you should discuss pain management with your doctor, who will be much better able to recommend something that won't aggravate other medical conditions. Is there a specific reason why your doctor hasn't prescribed painkillers or anti-inflammatories for you? Keep in mind that sometimes, we as patients get a little passive in a doctor's office and don't ask for what we need. When you have RA or osteo, it is normal to have to live with some degree of pain, but we can end up feeling like we have to just accept pain and forget to ask for help if it increases. If you have a lot of pain that significantly interferes with your ability to live your life, asking for stronger pain meds is reasonable.

 

Good luck!

 

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By hopeful— Last Modified: 06/13/12, First Published: 07/20/08