RA

Over the past 11yrs I have suffered 8 recurrances of Rheumatic Fever each episode usually lasting around 6-10mnths,waxing & waning after 3mnths. The more episodes I suffered the longer the episodes seem to last and became closer together. The 1st 2 episodes lasted only 4months.I am still in an episode now-10months.

After recent heart failure and ballistic chorea movements with other chorea symptoms i'd complained of previously-inability to concentrate & write, severe generalised muscle weakness, fever, tics & severe twitching like movements/feelings, always dropping things and severe restlessness etc I tested positive for Strep A & I requested 2be sent to an immunologist & cardiologist for assessment,who dx Rheumatic Fever.

I was previously dx with HLBA27 arthritis after a arthroscope& negative biopsy of my knee,& tests 4gonorreah,syhillis,RFactor were all negative.No ASOT was done even thou PH age 7 of RF.

For the past 6yrs i've being treated with Doxycycline for the "arthritis" and would intermittently take voltaren when the pain was severe,including chest pain dx as arthritis-which included palpitations & SOBreath-no echo or ECGs were done.

After the 4th recurrance of RF, 3fingers became involved "permanently" the pain was intermittent but the swelling seemed to never really disappear in my index & middle finger, unlike other joints which resolved after a wk-days. The nodules were dx as Bouchards & Heberdens nodes but when penicillin was started 12/05 these "nodes" disappeared & the 3 fingers involved which had began to appear "bent" started to straighten and I had much more sensation & strength in them and was able to massage areas which had been previously hard "away" (massaging caused pain in my wrist) & now I can almost totally bend them with no pain.

With my RF I suffered arthralgias, fever, rash, Sydenham's chorea and carditis(valve damage)-including pulmonary edema-including my fingers/hands.

RecentMRI of fingers reads:Effusions at ring long & index finger MCPJs.Marginal erosions noted at the ring finger metacarpal head & at index finger & long finger metacarpal heads although these are smaller.Fluid & soft tissue surround the index finger common flexor tendon,suggesting tenosynovitis.At the long finger &index finger PIPJs small joint effusions are present.No definite bony erosion is seen at these joints.Xray clear

My questions Does this mean I have RA as well as RF-could the Strep A have caused the RA also?Is it possible after so many recurrances to have this damage from RF?Could the fluid in my fingers(like digitalis)I was retaining which seemed to be difficult to massage away from my hands unlike in my legs etc contributed at all to it,or my playing netball and injuring them during a game?
Is my cartildge still intact?
Should I get tested for something else

What would u suggest I do in the future- to repair or reduce the current damage or control any further damage to these joints with minimal drug useThx

[Kevin Pho, MD]

To answer your questions:
1) The diagnosis of rheumatoid arthritis is normally made from a combination of lab results, x-rays and clinical features.  Rheumatoid factor is present in onl 70 to 80 percent of cases.  From the description, there is certainly a possibility that RA is present.  

2) RF can lead to a post-streptococcal reactive arthritis that may present in similar fashion to RA.  I am not aware of a direct cause from RF to RA.

3) It may be possible for the findings to be linked to the multiple occurances of RF.  

4) The MRI would be able to determine the status of the cartilage in your joints.  It is more likely that the fluid in the joints is caused by the RA or post-infectious arthritis, rather than the fluid leading to the disease.

5) I would consider another rheumatology evaluation at this point - preferably at a major academic medical center.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
kevinmd_b

[Karonnie]

Oh and my ANA's and CRP were negative, and my ESR is only 2!