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Diagnosed with RA
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Diagnosed with RA

Hello.
I'm 24 years old female,I was hospitalized 5 years ago because of a cold, I had a fever and after a week my knees and my left ankle rashed, the result of hematology tests showed that my ESR was high,and I got stiffness and swelling on my left ankle.
I was diagnosed with Rheumatoid Arthritis. they prescribed prednisolone for me (six 5mg pill per a day) during my hospitalization as well as chloroquine, Folic Acid and calcium for me.

The treatment went well and after a while they decided to lower the dosage step by step, it took 2 years for me to walk normally again (July-August 2009).

After about 6 months (February 2010) the stiffness came back and I had difficulties in walking. then again the doctors decided to increase the dosage of my medicines.and also add Methotrexate to my prescription.
I did more that 7 different tests during this past 14 months  (as you can see in my test results page) and ESR was abnormal but R.A. RF latex and CRP were normal in all of them ( everything else was pretty much OK)

I also had a MRI of my left ankle, result was no cortical erosion but soft tissue swelling observed and it came to a conclusion that the swelling and stiffness might be a cause of brucellosis (May 2010), I took the test and the result was positive! I tool the necessary medicines for 2 months and then took another test and the result was OK.( about 5months ago).

during that time (past 14 months) my illness was at it's peak I always took:
1- prednisolone (5mg) (1.5 per day)
2- chloroquine ( 2 pills per day)
3- Methotrexate ( 2 pills a week)
4- Folic Acid (2 pills per day)
5- calcium (2 pills per day)
6- indometaicin (2 pills per day)

I was just looking at the list of RA symptoms and I have very few of them:

1. Morning stiffness lasting at least 1 hour. (NO, it's the same as the rest of  the day for me )
2. Soft tissue swelling of at least 3 joints. (NO, just my left ankle is engaged)
3. Swelling of proximal inter-phalangeals and metacarpophalangeals. (NO)
4. Symetric pain. (NO)
5. Subcutaneous nodules.(NO)
6. Positive test for rheumatic factor (RF). (I was Negative)
7. X-ray erosions.( didn't show any erosions)

Now my questions:
1- How is it that there was not a single day in this last 14 months that I didn't feel well? is it the nature of RA?

2- With all those diagnostic test results, is it possible that they got it all wrong? I mean why the treatment isn't working for 14months?

Many thanks in advance.
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1193998_tn?1265121197
It isn't at all unusual to test negative in your bloodwork for RA, but have all the symptoms. It's called "sero-negative" RA. I myself have been in a full-body flare and my bloodwork show nothing until AFTER the flare is over. Your rheumatologist is right to keep treating you based on your symptoms, not just the numbers on a chart. No two RA patients are alike in terms of how their symptoms manifest, how severe they are, how fast the disease causes damage, and what medications work. Your list of seven typical RA symptoms is only a guideline; patients may exhibit all of those symptoms, only a few, or have an entirely atypical set.

If you feel you aren't getting quite enough relief from the mtx/chloroquine combination, I'd say ask about trying a different combo. There are many new meds out there now, though again, your rheumie is right to try the "first line" meds like mtx and chloro first. (They're generic, cheaper, and often work for a large number of people.)

I'm assuming that 2 pills a week of mtx is two, 2.5 mg pills. This is a pretty low dose and you have room to increase it. I take the equivalent of 8 pills (20 mg), except I do the injections, not the pills. You might also ask about dropping the chloro and adding something like Enbrel or Humira, which are among the newer meds. I take Enbrel along with the mtx.

You're on a pretty low dose of prednisone, but keep an eye on that bone density and watch for other long term side effects, as well. If you can possibly wean of it completely as you find a better combination of meds, please do. It's best not to take it long term.

Hope this helps!
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9 Comments Post a Comment
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Avatar_f_tn
sorry your feeling so down...have you had a bone density test? how much do you weigh? how many different medications your taking? thats so much for some one so young...
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Avatar_f_tn
Thanks for your reply, I had 2 density test one of them was 2 years ago and the other one was last year, both results were OK! I'm 56kg right now, 165cm high.
as I told you in my previous post I'm taking:

1- prednisolone (5mg) (1.5 per day)
2- chloroquine ( 2 pills per day)
3- Methotrexate ( 2 pills a week)
4- Folic Acid (2 pills per day)
5- calcium (2 pills per day)
6- indometaicin (2 pills per day)
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1193998_tn?1265121197
It isn't at all unusual to test negative in your bloodwork for RA, but have all the symptoms. It's called "sero-negative" RA. I myself have been in a full-body flare and my bloodwork show nothing until AFTER the flare is over. Your rheumatologist is right to keep treating you based on your symptoms, not just the numbers on a chart. No two RA patients are alike in terms of how their symptoms manifest, how severe they are, how fast the disease causes damage, and what medications work. Your list of seven typical RA symptoms is only a guideline; patients may exhibit all of those symptoms, only a few, or have an entirely atypical set.

If you feel you aren't getting quite enough relief from the mtx/chloroquine combination, I'd say ask about trying a different combo. There are many new meds out there now, though again, your rheumie is right to try the "first line" meds like mtx and chloro first. (They're generic, cheaper, and often work for a large number of people.)

I'm assuming that 2 pills a week of mtx is two, 2.5 mg pills. This is a pretty low dose and you have room to increase it. I take the equivalent of 8 pills (20 mg), except I do the injections, not the pills. You might also ask about dropping the chloro and adding something like Enbrel or Humira, which are among the newer meds. I take Enbrel along with the mtx.

You're on a pretty low dose of prednisone, but keep an eye on that bone density and watch for other long term side effects, as well. If you can possibly wean of it completely as you find a better combination of meds, please do. It's best not to take it long term.

Hope this helps!
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Avatar_f_tn
Yeah I remember in my previous session with DR, he mentioned somthing about  seronegative RA.
And you're right I think this combination isn't working for me. I mean after taking prednisone for this long it's one of those things that's worries me the most.I'm gonna ask my doctor to try another combination.
but what about brucellosis? could this stiffness and swelling on my ankle be because of it? (according to my tests results)
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1193998_tn?1265121197
All kinds of things can trigger the immune system to kick into overdrive and attack itself - bacterial and viral infections, high stress, an injury, basically anything that stimulates the human immune system. No one knows why one person develops an autoimmune disorder and the next person doesn't. My RA was probably triggered by a common childhood illness at age 5. My sister had it at the same time and she didn't develop RA. RA does run in my family, however that doesn't mean someone with no family history can't get it. *sigh* Something like brucellosis or lyme disease could indeed trigger your immune system, though I daresay if it hadn't been brucellosis, it probably would have eventually been something else.

I know, not much help, am I? :/  The mysteries surrounding the causes and effects of this disease are too many to count.
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Avatar_f_tn
I'm grateful for this information dear. you and the others were so helpful.
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1652468_tn?1302904098
Can someone share drug free treatment options for arthritis? Yesterday I was diagnosed by my orthopedic surgeon as having arthritis in my left knee.

I am in my 40's and a semi active golfer, any drug free suggestions will be useful, while I undergo three months of intensive physiotherapy for other issues with the same left knee.

Thanks in advance for your suggestions.
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1193998_tn?1265121197
You might try glucosamine/chondroitin supplements to support the cartilage in the knee. Over the counter NSAIDs may help some but you have to be as careful with those as with prescriptions as long-term use can be hard on the liver.
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Avatar_m_tn
Fight artritis with some natural methods.
Ayurvedic
1) Mix turmeric powder(haldi), Fenugreek powder(Methi) and ginger powder  in equal quantities and keep in a bottle. Take one teaspoon of this mixed powder in hot water twice a day.
2) Use mashed cabbage in poultice and apply to knee, and keep for upto 4 hours.

Light exercises -
1) Place your hands above the knees, and  swing round both knees , ten times in one direction, then ten times in opposite direction.
2) Sit on the floor, with the legs straight and hands on the floor behind you.
a) Lift the knees up and down,10 times, touching the floor with a thud.
b) Push the knee caps down and release, 20 times.
c) Bend and release the toes of both feet 10 times.
d) Bend both feet, forwards and backwards, 10 times.
e) Rotate both the feet 10 times in one direction, and 10 times in reverse direction.

Also do lots of Yog pranayam.
May 15, 2011
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