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ask: I have been diagnosed with osteoarthritis even thought I am sure it is RA.

By Anonymous
 
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I starting seeing a rheumatologist over a year ago. I had one test that came back negative for RA. I have researched and more testing is usually involved in regard to testing for RA. I have all of the signs and symtoms, and the disease has progressed 180% in less than one year. Not all people with rherumatioid arthritis test positive for the rheumatoid factor, especially early in the disease. My mother has Ra and I believe that I do as well but the rheumatologist disputes this and does not seem to take me or my questions about the pain, swelling,etc. as important. What would be the best way to get an accurate diagnosis? I have been receiving cortisone injections in my shoulders for about nine months but at best the relief only lasts about one month. I do not know where to get the best information.

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Pat Elliott

Hi flojoe - Sorry to hear the physical therapy has been painful for you, and that you found it to be a mistake. It's good though to see you feel empowered to seek a new rheumatolgist and get the support you need. Thanks for the update, and please keep in touch. If we can help, let us know.
Take good care,
Pat

December 5, 2009 - 12:16pm
EmpowHER Guest
Anonymous

Hi Anon- I'm having a very similar experience - RA symptoms for about a year (swelling and nodes on fingers of both hands, extreme fatigue) and have a mother with RA, only I'm 43 and am experiencing this about 20 years younger than she had. My rheumatologist (whom I received the referral to only after a year of requesting) says that my presentation is atypical, but at my last appt finally conceded that "it might be RA." My mother also had a hard time getting her diagnosis (having an atypical initial presentation identical to mine) and is also negative for Rh factor in her blood tests. I'm only being treated w/ various NAIDs so far, but want to try a more aggressive treatment to prevent joint damage. I see my rheumatologist next week and hope to get that (I also have some overlapping OA, primarily in the knees and back). My only advice is to perservere - it took my mother about 2 yrs to get a correct diagnosis, but she finally did, so I guess that's why I'm still hoping my dr will come around! Good luck, I hope you found another dr and are feeling a bit better.

December 1, 2009 - 11:19am
flojoe57 (reply to Anonymous)

I did not contact another doctor yet. I did however see her 3 weeks ago and she asked me to skip the injections in my shoulders this time and wanted me to try physical therapy. ( to learn excercises to strenghten my shoulders) Monday will be my last day of p.therapy and it was definitely a mistake. The excercises have made my shoulder joints worse than they were before. I am in far more pain now than I was before. Now I think would be a good time to search for a new rheumatologist.
Thanks for the advice. I only hope that I can find a rheumatologist that is willing to perform all of the bloodwork required to diagnose RA,

December 5, 2009 - 10:37am
Alison Beaver (reply to Anonymous)

Anon,
Thanks for sharing, and please let us know how your appointment is with your rheumatologist next week!

December 1, 2009 - 3:36pm
Pat Elliott

Hi Anon - Thanks for writing to us. Alison provided a lot of information and links, and I hope you've had the time to digest this. How are you doing now? Have you seen a new doctor? Have you gotten more information? Or, have you ended up with more questions than answers?
Please let us know how you're doing, and if there's anything we can do to help. We have a lot of resources that we're happy to share.
Take good care,
Pat

November 24, 2009 - 6:20pm
Alison Beaver

Thanks for writing back so soon! Let me know if this information is helpful, as it is a great deal of information and I am happy to review it with you, or condense it further. I assume you know a great deal about Rheumatoid Arthritis (RA) and Osteoarthritis (OA) and do not want to provide repetitive information, but wanted to be thorough.

There are some distinct differences between RA and OA, including the symptoms you described as experiencing, as well as some specific diagnostic tests used to determine and differentiate the diseases:

RA:
- effects small joints in hand, wrists and feet primarily
- there is a characteristic pattern of joint disease present
- prolonged morning stiffness is characteristic of RA (not seen in OA)
- stiffness is worse in the morning (not characteristic in OA)
- loss of energy, low-grade fevers, loss of appetite
- dry eyes and mouth
- firm lumps/nodes in elbow or hands may be present

OA:
- primarily effects knees, hips and spine (knees may not be affected in RA)
- discomfort with walking or standing (not characteristic of RA)
- can affect fingers, and patient can have bony knobs/nodes
- generally no prolonged morning stiffness, unlike in RA where this is characteristic
- pain relieved by rest
- overall stiffness in morning, or after prolonged inactivity; typically lasts no more than 30 minutes (not usually described as "prolonged" stiffness, as there is with RA)

From your description of your symptoms alone, compared with the lists above, I can see why your rheumatologist would diagnose OA rather than RA. However, there is overlap with the two conditions and one condition that is "characteristic" of a particular disease does not necessarily rule out the other disease; I just can understand where your doctor is coming from with his/her diagnosis. However, there is much more than just "understanding" the doctor; there are specific diagnostic tests and pattern of disease that accompany each individual condition...so it can be less of a guessing game and you can have more accurate results (with subsequent treatment tailored to you and your condition).

I have included some more information to distinguish OA and RA. I am curious what tests (from the lists below) have you had, and do you know the results of each?

How is osteoarthritis diagnosed?:
"OA is suspected when patients have pain in the commonly involved joints. It can be confirmed by physical examination showing bony enlargement, fluid accumulation, cracking sensation during movement, muscle weakness and joint instability. X-rays also are useful in making the diagnosis. Occasionally blood work may be necessary to rule out other diseases."
Source: American College of Rheumatology: Osteoarthritis

How is rheumatoid arthritis diagnosed?
The diagnosis of RA is based on the symptoms described and physical examination findings such as warmth, swelling and pain in the joints. Certain blood levels commonly found in RA can help in establishing a diagnosis.
Tell-tale signs include:
* Anemia (a low red blood cell count).
* Rheumatoid factor (an antibody eventually found in approximately 80% of patients with RA, but in as few as 30% at the start of arthritis).
* Antibodies to cyclic citrullinated peptides (CCP).
* Elevated erythrocyte sedimentation rate or "sed rate" (a blood test that, in most patients with RA, tends to confirm the amount of inflammation in the joints).

X-rays can be very helpful in diagnosing RA, but may not show any abnormalities in the first 3–6 months of arthritis. These X-rays are, however, useful in determining if the disease is progressing. MRI and ultrasound are also being used more frequently to help detect the severity of RA.

It is important to remember that, for most patients with this disease (especially those who have had symptoms for fewer than six months), there is no single test that “confirms” a diagnosis of RA. Rather, diagnosis is established by evaluating the symptoms and results from a physical exam, laboratory tests and X-rays."
Source: American College of Rheumataology: Rheumatoid Arthritis

Other great sources of credible medical/health information:
- NIAMS (National Institute of Arthritis and Musculoskeletal and Skin Diseases): Rheumatoid Arthritis
- NIAMS: Osteoarthritis
- NIH (National Institute of Health): Arthritis
- NIH (National Institute of Health): Osteoarthritis

Online Screening Quizzes
(please know: I am unsure about the credibility of these sources of quizzes, but they seem helpful. Please verify information from this site with other credible health/medical sites above)
- Osteoarthritis Screening Quiz
- Rheumatoid Arthritis Screening Quiz

Find a doctor:
Find a Rheumatologist

Please let us know if you need additional information, or if you would like us to summarize or condense the information...especially from the NIAMS sites.

November 8, 2009 - 7:49pm
Alison Beaver

I am glad you found EmpowHer, and we can definitely help provide you with information and resources!

Can we start from the beginning, and have you describe for us your symptoms?
How long have they been lasting? What is your age and other diagnosed medical/health conditions?
One important factor is that you have a family history of RA.

What are the treatment options provided to you for easing your pain and swelling? What are the treatment outcomes expected with cortisone injections (temporary pain relief, more permanent pain relief, or other?). Has your doctor provided you with additional information or resources?

Hope to hear from you soon!

November 8, 2009 - 8:55am
EmpowHER Guest
Anonymous (reply to Alison Beaver)

I am 57 years old and have had minimal symtoms up until about one year ago. I have knodes on the fingers of both hands, have stiffness and pain in both shoulders ( site of the injections) and last spring began to have problems walking. After being on my feet all day at work I would sometimes have problems walking and standing. I now have pain and stiffness in the left knee. I did try to speak to the rheumatologist about the decling but he did not seem interested and offered me a new script for inflammation.(Etodolac) It did not work and I have tried 2 others that did not work. I stick to ibprohen. I also resigned from my job in October of 09, due to the pain and the doctor has not provided me with additional info. New doctor you say? I am looking for one . Thanks for any info you can provide me.

November 8, 2009 - 4:57pm
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