Rheumatoid Arthritis Question # 2

[mamabland]

Hi Dr. Keyes.  I know how valuable your time is and did not want to try to get away with 20 questions in 1, so to speak!  I truly appreciate how much your insight has helped.  You have saved me and my PCP a lot of time, $$ and frustration.  Your hypothesis regarding the HS regarding my skin probs is totally in line with all the findings.  The funny thing is that I have spent the last 4 months or so on-line looking up dermatological dz photo's to try to identify mine and never even saw HS!!  You suggest it, I looked it up and voila!  Pictures look quite a bit familiar, esp the scarring ones, although mine occur singularly so far, thank God!  Hopefully, they will not progress to that twisted, burn damaged skin look!  Also, the androgen dyfunction fits as well.  Maybe that is why antidepressants are NOT working very well!
In that last post I mentioned that I am waiting for auth on a MRI of lt hip and lt knee.  Will the MRI show damage only or can it distinguish between regular arthritis and RA damage in its findings?  I am just so ready for a diagnosis and treatment plan.  I want to feel better!  Thanks again Dr. Keyes.  May God bless you and the angels watch over you too!  You deserve it.

[J.M. Keyes, MD]

Hey Terri,
Sorry it's taken me so long to get back to you.
Up to 15% of people with RA have a negative rheumatoid factor, so that certainly doesn't rule anything out.  RA is a clinical diagnosis, so it more depends on whether you have enough of the symptoms/findings to meet the diagnostic criteria.  Also, some people without RA have a positive RF, so the bloodwork on it's own doesn't really tell you much.
Re: the MRI- it should be able to distinguish between osteoarthritis and RA- I asked an orthopedic colleague and he said that an MRI will show fluid, the amount of cartilage lost, and the changes in the synovium; but again, that it is ultimately a clinical diagnosis.  Hopefully, after your MRI, your PCP and/or rheumatologist will be able to put the whole picture together for you.
I think if that can happen it will go a long way in making you feel better- even psychologically- it is always easier to battle something when you know what you are fighting against I think.  I imagine a big part of your frustration is not knowing what is going on.  Again, this is a million times harder for someone like you, who is used to being active, independant, and everything to everyone.  
I really wish you the best of luck with this.  I can't imagine how much it must be wearing on you and your family.  Keep your chin up Terri.

JMK MD

[mamabland]

Thank you.  You truly hit the nail on the head.  The "not knowing" is hell.  Even though my doc does not treat me like I am a hypochondriac or something, there are still those that I come into contact with that treat me, well, you know what I mean.  Being in medicine for so long, I can sense it.  Although what others think really does not amount to a hill of beans.  For myself though, it is being unable to have a game plan, to know what I am fighting and how best to fight it, especially not knowing IF it can be fought!  That all compounds the depression caused by sense of loss of self, you know?  

I certainly hope that I have not come across as totally manic on here.  I have to say though, that your advice has really filled in the blanks and kept me from going off the deep end.  Especially with the comedy of errors that was my PCP's so-called MA, who had no experience except for phlebotomy!!!! (They are still finding charts that she buried because she didn't know how to something or other!!!)  At any rate, it has been a long road, but I really feel like I am within inches of the finish line and once there I will fight it and I will win.  Thanks again for your patience, great medical advice, and most of your compassion.  It has made all of the difference.  Take care!
Terri

[mamabland]

Whoops!  That was supposed to read: "...and most of ALL, your compassion."  Sorry, that sounded kind crappy the way it was written!  
Ahhh, I need to go to bed, can't even keep my eyes open!

Thanks again!