What is the difference between RA and inflammatory arthritis

09/02/09

gma2

Topics:Joint Pain , Rheumatoid Arthritis Symptoms , Diagnosing Rheumatoid Arthritis , Rheumatologists , Rheumatoid Factor , Methotrexate , Prednisone , Coping With Chronic Pain

My rheumatoid factor is always negative so my rheumatologist says I don't have RA but rather inflammatory arthritis. What's the difference please? I am on prednisone and injectable Methotrexate.

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Answers (5)

Thursday, September 03, 2009

Lene Andersen

Approximately 20% of people who have RA are what is called seronegative - in other words, their RA factor tests negative. You can read more about lab results here.

As far as I can tell from a brief visit to Google, inflammatory arthritis involves the autoimmune system and therefore appears to be another word for rheumatoid arthritis (you can see more about that here). Both prednisone and methotrexate are common treatments off RA, so I'm not really sure where your doctor is coming from.

I would recommend that you ask for some more details about his diagnosis including an overview of the differences between RA and inflammatory arthritis as he sees it. You may also consider getting a second opinion.

Thank you for your input
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re: What is the difference between RA and inflammatory arthritis
gma2
Monday, September 07, 2009 at 05:46 PM

Thanks so much for your response; i've been under the weather and apologize for taking so long to respond. You make so much sense out of what has caused me so much confusion as I have other medical issues. I almost need a 1,2,3 approach to figure things out especially when given different answers by different doctors. I will check out your links and again thanks for helping to guide me in this puzzle of my body.

re: re: What is the difference between RA and inflammatory arthritis
Lene Andersen
Tuesday, September 08, 2009 at 12:56 PM

You know that story about how when you get directions, you need to ask three people and choose the way two of them tell you? You may be in the same situation that you need to see a number of doctors until enough of them agree. Not easy, but I'm sure you'll get there sometime and I hope you'll find some answers soon.

re: re: re: What is the difference between RA and inflammatory arthritis
gma2
Thursday, September 10, 2009 at 02:15 PM

Yes, I do know what you mean it's just so frustrating becasue I've been dealing with this for so long and I'm sure I'm not the only one. On a light note, do doctors ever agree...one rheumatologist I was seeing had to leave his practice for personal reasons and he said the one I was changing to was a good one. Well the new rheumatologist said he didn't understand why the old one said I had undifferentiated connective tissue disease. (shrug) Thanks for your answer

re: What is the difference between RA and inflammatory arthritis
Ellen
Thursday, September 10, 2009 at 10:02 AM

There are a couple of other terms and distinctions that are thrown around ...

* There is infectious arthritis, which can result from certain bacterial or viral infections; when the infection is cleared up, there may or may not have been damage, but the arthritis does not continue & progress (in my understanding). This is not RA but may involve inflammation during the active infection. I think parvovirus is one of these, and also I saw a program once where salmonella from contaminated ice cream can cause inflammatory arthritis in people who are sensitive to that bacteria - several teens out West suffered permanent damage and continuing problems from having eaten the ice cream, whereas everyone else got sick for several days from salmonella but then were fine.

* There is osteoarthritis, which is usually the opposite of RA or inflammatory arthritis, the slow grinding & wearing down of cartilage, especially in knees & hips, that can cause a lot of pain, but not the swelling & warmth that is associated with RA or inflammatory (read: heat/inflamed) arthritis.

Sometimes rheumatologists will take samples of joint fluid to test for the presence of bacteria or other signs of infection. (I cringed at my first rheumatology appointment when my dr. said they might do this, but he said it is not usually difficult or painful, and as it turned out, the blood tests were definitive and more was not necessary. In fact, in some cases, I've heard that joint fluid will be removed to lessen the swelling & pain!)

Hope this helps!

re: re: What is the difference between RA and inflammatory arthritis
Nana
Thursday, September 10, 2009 at 10:40 AM

My blood showed negative when I was first diagnosed, ten years ago. But my doctor said that I did have RA, he did x-rays and was able to tell that way. Now my blood work does show positive. Like the others said you are taking great meds for the RA.

Good Luck.

re: re: re: What is the difference between RA and inflammatory arthritis
gma2
Thursday, September 10, 2009 at 02:31 PM

Thanks for your input Nana. I hate the methotrexate, it seems that it is now destroying my nailbeds although I haven't looked that one up yet. The prednisone makes me angry according to my counselor and added unneeded weight to my diverse back problems. I guess one has to make a choice of what to take against the pain. Frustrating

re: re: What is the difference between RA and inflammatory arthritis
gma2
Thursday, September 10, 2009 at 02:26 PM

That virus thing is creepy because I have eczema too and when I was on penicillin for a bad tooth it went away. As for the fluid thing, I also have nonspecific chronic papillary synovitis in my knee and when my current rheumatologist withdrew fluid from my left knee that he said was hot it hurt something awful, like someone was pulling a string out of my leg. Perhaps this is a big part of my issue, arthritis, synovitis, eczema, high uric acid levels (gout); these are all, to my knowledge, forms of arthritis. No one in my immediate family has had these problems to this degree so that brings in the domestic violence issue (damaging the immune system I believe). Geez, it goes on and on and twists and turns. Thanks for your input.

re: re: What is the difference between RA and inflammatory a
gma2
Wednesday, September 30, 2009 at 08:39 PM

Hi Ellen, I remember the ice cream case. As for the osteoarthritis I seem to have that too or instead of. My knee surgeon operated on my left knee for 2 torn meniscus and also withdrew some fluid from my knee. It came back as non-specific chronic pappillary synovitis. Needless to say, I'm still confused. That surgery was about 3 years ago and then in the last couple of months my rheumatologist said my left knee was swollen and hot and he withdrew more fluid. Come to think of it I never asked what it showed; I have to remember that when I see him next week. I'm some kind of puzzle that the docs can't figure out I guess...

re: re: re: What is the difference between RA and inflammatory a
Ellen
Wednesday, September 30, 2009 at 09:28 PM

Well, you know what they say about "practicing medicine" .... from what I've seen on the Discovery Health channel, there are a lot more mysteries than we often think. Diagnoses are not simple and clearcut in many cases ... I guess I was one of the textbook cases as far as diagnosis - but then again, maybe not. My doctor thought I had fibromyalgia at first, even though I tested positive for rheumatoid factor. Then 2 months later with my wrist swollen halfway up to my elbow, he said, 'uh - maybe we'd better do those tests again!" and I think he felt really bad! I have a younger sister and an older sister who BOTH have polymyalgia rheumatica, and the younger one is at least 10-15 years younger than usual for that to happen. (I keep thinking maybe it's just 'undifferentiated arthritis' as this point and maybe she'll join me in 'keeping the family tradition' of RA. I have 4 sisters, none with RA but my cousin, aunt and grandmother all had/have it.

The cousin with RA has 2 sisters who have both come down with Type 2 diabetes - another autoimmune disease, they now say. One drank her way there (has liver problems 2), the other probably not. A third cousin from another branch also just got diabetes - with no risk factors and no family history. There is just no one answer that accounts for everything.

So - I guess all we can do is take it one step at a time, don't rely totally on the docs, do our own research, make sure they do know what's happening... don't assume they pick everything up. I always forget to bring up something, even when I try and make a list ... my brain was never the most organized, and the drugs don't always make that better - LOL!

re: re: re: re: What is the difference between RA and inflammatory a
gma2
Friday, October 02, 2009 at 07:47 PM

Hi Ellen, I think I missed this post somewhere along the line. My primary doc first diagnosed me with polymyalgia rheumatica, then my 1st rheumatologist diagnosed me with myositis, undifferentiated connective tissue disease and inflammatory arthritis, then the 2nd and present rheumatologist said he didn't understand why the 1st one said he thought I had the connective tissue thing (no one did a muscle biopsy) and I definitely didn't have the polymyalgia rheumatica thing or myositis so according to him I just have inflammatory arthritis. Oh, I brought up Marfan's with the 1st rheumatologist and he dismissed it; didn't want to hear about the members in our family who had died from it or the fact that I have many markers of Marfan's.

Currently, I cancelled my 3rd epidural for this past Wednesday in hopes of using it when the weather gets much colder but already I feel more pain. This makes me wonder about the MTX; I thought it was working finally against the arthritis pain but it's slowly coming back. That leads me to wonder if my pain is really all from my back and if so where does the arthritis come in. As you said about being organized all this info just causes more confusion and my meds *do* make it harder to compartmentalize all these meds/symptoms, etc.

Be well and thanks for your input.

Marfan's
Ellen
Sunday, October 04, 2009 at 06:30 PM

Hi again - if you have Marfan's in your family, have you been checked for some of the more dangerous things related to it, like the abdominal aortic aneurysm? Just wondering ... I would think even your regular doctor could order that test. That would seem like something you wouldn't want to let slip through the cracks.

Wishin you well -

Ellen

Thursday, September 10, 2009

Lisa V

I, like several others, was initially diagnosed with inflammatory arthritis because my RA Factor was negative. My diagnosis was actually referred to as Inflammatory PolyArthrosis (IPA) ... because the inflammation / pain was bi-lateral. My doctor explained that this was basically the diagnosis for sero-negative RA and began treatment with Methotrexate and intermittant steroids for flares. When I didn't reach full pain-free status with 1.0CC (10 pills for those doing it orally) Methotrexate, we discussed adding a biologic. My choice was Humira. In the transition to the additional medication, my diagnosis was changed to RA (sero-negative) for insurance purposes, as she stated that insurance would only pay for the medication if it was used for FDA approved uses - RA being one of them. I never thought I had anything less than sero-negative RA, but it was 12/30/09 when I actually got the diagnosis. Now when I go in, we talk about the status of my RA rather than the status of my IPA symptoms. Strange demarcation, but that's how it worked for me.

Thank you for your input
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re: What is the difference between RA and inflammatory arthritis
gma2
Thursday, September 10, 2009 at 02:37 PM

Hi Lisa, I've not heard of IPA but my pain is all over which I guess could be called bi-lateral (shrug). No dr. has ever told me about the sero negative thing (I meant to say this earlier). When I was taking Methotrexate pills, I came down with methotrexate poisoning at 8 pills hence the change to the shots. That insurance purposes thing drives me nuts. I wish you well

re: What is the difference between RA and inflammatory arthritis
Ellen
Thursday, September 10, 2009 at 02:58 PM

SO - from all that I'm reading, sounds like the doctors are cautious about absolute naming until there's a full picture, or a practical need to be more definitive. This one question has brought together a multitude of people with different symptoms, but all involving inflammation, which just shows the diversity of arthritis - I've read that there are about 100 different kinds of arthritis, including gout.

That's interesting about the eczema going away when penicillin was taken. I've developed some kind of 'eczematous folliculitis', as my doctor calls it - meaning, it's not infectious but due to some other kind of reaction in my body. I was afraid it was an allergy to Enbrel, but neither doctor thinks so and both say not to worry.

I have heard of arthritis going away when someone was fighting cancer, believe it or not. Arthritis can go away during pregnancy - and then return afterward. I also have found that when I've had to go off Enbrel for a sinus infection, that my arthritis has not (in that 2 weeks) gotten worse - if anything, it's better, and I think it must be because my immune system is busy fighting off something else OR because somehow the antibiotics help. There is apparently an anti-inflammatory effect of antibiotics...

Some people think that there is a kind of 'cell-wall-deficient' bacteria living IN the immune cells making them go wacko, that they are hidden from the immune system in that way, and most antibiotics can't reach them. (A lot of antibiotics destroy the cell wall, but if they don't have one .... the bacteria live in films, colonies or as spore forms. Only tetracycline/minocycline-type antiobiotics work, and they're given in low doses over a long period of time so the body doesn't become allergic and the bacteria don't get resistant.) There's a classic book by Lida Mattman about this; unfortunately, rare and expensive. I think you can see it and/or read it on Google you're interested, but it's for scientists mostly, I think. (It's said that with great difficulty they can actually see the germs in the immune cells!) Now that's pretty tricky of those pesky germs!

Friday, September 11, 2009

01titansfan

There are over 100 types of arthritis and I'd bet even rheumatologist can't name them off hand. I do know that inflammatory arthritis is not just another name for sero-neg rheumatoid as some people have told you. There is also such a thing as inflammatory osteo-arthritis but it is not real common, but not considered "rare" either. Inflammatory arthritis is usually treated the same as Rheumatoid ie... mtx, arava, prednisone, enbrel, etc... Ask you M.D. if you are that concerned but I bet he'll just tell you it's just another type of arthritis since they still do not fully know the whys and hows of auto-immune diseases. I know it's not a complete answer but I hope it helps. I just didn't want you to believe all inflammatory arthritis is a form of RA, because it is not!

Thank you for your input
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re: What is the difference between RA and inflammatory arthritis
gma2
Wednesday, September 30, 2009 at 08:46 PM

Hi Titan, I understand exactly what you're saying, arthritis is a tricky and nasty thing. Any kind of input is greatly appreciated and I especially appreciate your reminding me that all inflammatory arthtis is not a form of RA. My fingers may ache but there is no deformity.

Tuesday, September 29, 2009

MTC

Hi. I think I have the same arthritis. It is called Seronegative (RA-) Inflammatory Arthritis. I started also with Prednisone and Embrel. Methotrexate I believe is too strong in some cases. I don’t know your age but I’m 30 (I was diagnose at 19) and since I want to have kids that’s not an option for me. http://rheumatology.oxfordjournals.org/cgi/content/abstract/26/3/172

At this site you have the answer for you question…. “A case control study of 50 rheumatoid factor positive (RA+)and 50 rheumatoid factor negative (RA–) patients withrheumatoid arthritis has been carried out. As expected, theRA+ group has significantly more nodules and vasculitis. Interms of clinical joint involvement, the RA– had large-jointinvolvement. Radiologically, seropositive disease was characterizedby more severe involvement of the metacarpophalangeal jointsof the thumb and index fingers and in all the metatarsophalangealjoints of the feet.”

Hope this help.

Thank you for your input
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Tuesday, September 29, 2009

MTC

At this site you have the answer for you question…. “A case control study of 50 rheumatoidand 50 rheumatoid factor negative (RA–) patients withrheumatoidarthritis has been carried out. As expected, theRA+ group has significantly more nodules andterms of clinical joint involvement, the RA– had large-jointinvolvement. Radiologically, seropositive disease was characterizedby more severe involvement of the metacarpophalangeal jointsof the thumb and index fingers and in all the metatarsophalangealjoints of the feet.” factor positive (RA+) vasculitis. In

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re: What is the difference between RA and inflammatory arthritis
gma2
Wednesday, September 30, 2009 at 09:01 PM

I just turned 60 and it seems that the sero negative thing is about right, at least to me. I understand about the MTX and a strange, at least to me, thing occurred recently with regards to it I think. I was very sick at the beginning of this month, low-grade fever, extreme fatigue, burning up with like heat coming out of my head, a sore throat; i isolated myself for about 5 days and it took awhile to get my strength back...I still sleep a lot. I was being treated by a new internist who said she didn't think I had the "flu" but sometimes I wonder. I went back to my long time primary doctor and he didn't think I had it either. I got the seasonal flu shot.

A new symptom came up shortly after that illness; white spots in my mouth. It wasn't thrush from my Advair but I learned something from my dentist. She said it was a fungus and because of the MTX (and the prednisone) my body is very susceptible to oportunistic infections. My rheumatologist has never said this to me. I'm not the best at caring for my teeth but now I have no choice. She prescribed Nystatin mouth wash for the fungus and it seems to be working already (2 days) but of course I will continue with the full dose. And as for the nail fungus, the same thing, an oportunisitc body sucks, it's like I've got this sign on me...hey bugs here I am . I hate going out in public because no one here is taking precautions against the dreaded swine flu and that's the last thing i need. It seems like after I was ill my immune system totally shut down...I will push my rheumatologist for a difinitive answer to that one. However, the MTX has helped with the arthritis pain, I've even been able to cut back on my Neurontin for knife-like pains from fractures in my back and spinal stenosis, or...it's the 2 epidurals I've had. Like my primary doctor has said more than once I have numerous problems. Thanks all for your input, it means a lot to me that all of you care enough to post.