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[lizzog]

I'm 59, on HRT and post meno.
Since late last year I've been gradually getting swelling in my ring finger middle joint.  I had bloods done for suspected RA and told that because my Rheumatoid factor was only 12, it needs to be 15 to be referred to the NHS, so I ended up going privately to see a Consultant.  I had to have my wedding ring cut off, and now it seems to have started on my other hand on the same finger, and I can see my little finger is bending a bit.
I've been told to have x-rays and scans on my hands and feet and then potentially start medication to see if it helps dependent upon the outcome.
My sister has very bad RA (or so I thought), but is due to see a consultant about it next week as they are querying whether it is actually OA now....
Her hands are very misshapen and she is getting swelling in her feet now too.
I am 12 years younger, and want to try and either nip this in the bud before it gets to the point of extreme pain, or at least get a clearer diagnosis.
The working diagnosis seems to be inflammatory OA - not sure if that's the same as seronegative - it's all very confusing.
If anyone has any pearls of wisdom, or similar experiences please let me know as I'm finding the process of getting a diagnosis a bit frustrating....

[CLKD]

Morning.  I don't understand this problem with diagnosing RA - it's painful, the joints swell and become reddened, quite obvious in the active stage.  OA is aging, normal deterioration between the joints = inflammation and pain on activity.  1 can be affected with both!  Gold injections were used into RA joints years ago.

R U able to explain 'seronegative'? 

It is negligible that you have been refused an X-ray!  That seems like a complete co-out quite frankly.  Pain in the joints is that, pain in the joints and an X-ray will give a clearer diagnosis!  Going private may well give you more time to discuss your symptoms - do take a list ! - and get a proper diagnosis. 

R U able to explain the 'bending' of the finger? 

Do continue with weight bearing exercises: brisk walking 10 mins every day will help stave off osteoporosis for example.  Joints need impact, so does the jaw which is why chewing is important to keep the bone healthy.  [which is why I opted for implants]. 

[chopsuey]

Inflammatory OA and seronegative inflammatory arthritis are different things. The former is age related, degenerative OA but with some acute, inflammatory aspects. RA and seronegative inflammatory arthritis are both autoimmune disorders, which will need specific drugs to moderate the actions of the immune system. Inflammatory OA is typically managed with NSAIDS ( ibuprofen etc).

An x-ray will show OA but not normally inflammatory arthritis/RA, at least in the early stages, as it is mainly affects the soft tissues. Only later can it start to erode the bone, if not managed well. For that reason, an ultrasound scan is normally carried out if RA/inflammatory arthritis is suspected. Seronegative just means there isn't Rheumatoid Factor or Anti-CCP in the blood but the presentation and management of the condition will be very similar to RA. Positive RF by itself does not mean you have RA, as it can be present in people without RA.

I hope you get your results and diagnosis soon.     

[CLKD]

Tnx for that update chopsuey .........

[lizzog]

Inflammatory OA and seronegative inflammatory arthritis are different things. The former is age related, degenerative OA but with some acute, inflammatory aspects. RA and seronegative inflammatory arthritis are both autoimmune disorders, which will need specific drugs to moderate the actions of the immune system. Inflammatory OA is typically managed with NSAIDS ( ibuprofen etc).

An x-ray will show OA but not normally inflammatory arthritis/RA, at least in the early stages, as it is mainly affects the soft tissues. Only later can it start to erode the bone, if not managed well. For that reason, an ultrasound scan is normally carried out if RA/inflammatory arthritis is suspected. Seronegative just means there isn't Rheumatoid Factor or Anti-CCP in the blood but the presentation and management of the condition will be very similar to RA. Positive RF by itself does not mean you have RA, as it can be present in people without RA.

I hope you get your results and diagnosis soon.     

Thanks for this - I've already had Rheumatoid Factor and CRP tests but I don't think Anti-CCP as that wasn't available on the NHS where I live.  Because my RF was too low to be referred on the NHS I went private on a GP referral so am waiting to go back to the GP to see if they can now refer me into the NHS - a lot of messing about but I want to be sure I get a proper diagnosis.  As I understand it from the consultant's letter, they are looking at the differential between early erosive OA versus seronegative inflammatory arthritis on the psoriatic spectrum.  I've also got a long standing achilles tendon issue and very dry skin which could point to it being inflammatory rather than OA. 
CKD - I did have an X ray under the NHS a while ago but didn't find anything but v small amount of OA.  The consultant I saw privately wants to repeat these and scans on my feet and hands too.

As far as exercise is concerned- I do plenty of weight bearing stuff - weights at gym x2 a week plus dog walking, swimming and pilates so I feel that I'm looking after myself.

[CLKD]

You R doing most of what can ease progression.  DH and I had a heated discussion yesterday on the back of this thread, him suggesting that due to protocols being set that GPs won't go over these due to being audited etc..  Instead of my thinking that GPs should treat on symptoms !  He's too analytical  .

As oestrogen levels drop the body may become dry: inside and out; scalp, skin, vagina, between the toes, deep in the ears, nostrils as well as muscles may become lax = aches and pains.  Natures elastic :-)

Let us know how you get on.

[lizzog]

A quick update.  Finally got an appointment with a really helpful GP who put me on a quick pathway to see a Rheumatologist.  He said he thinks I've got erosive inflammatory osteoarthritis, and did some more x rays and said I can have a steroid injection guided by ultrasound providing they can find a path in  - he also showed me the needle they would use, said diet and supplements not that helpful and basically made we feel really fed up.  My mum and sister both had/have it, so I wasn't that surprised.  Hopefully will be having the injection later in the year...

[chopsuey]

I'm glad you have now got a working diagnosis, although it sounds like the consultant left you feeling pretty despondant.

 I found an article in the American Jounal of Rheumatology on diagnosis and treatment of erosive inflammatory OA:
   https://www.the-rheumatologist.org/article/what-to-do-with-erosive-inflammatory-osteoarthritis/

I suggest you see if you can be referred to a hand therapy service, if they exist in your area, to give you advice on how best to manage this, whilst you are waiting for your steroid injection.

[CLKD]

The Consultant with whom I worked in the 1970s specialised in hand injury surgery.  I hated the Monday morning Clinics ........ 

tnx for the update.  Will those X-rays be available at the RA appt.?

[lizzog]

I'm glad you have now got a working diagnosis, although it sounds like the consultant left you feeling pretty despondant.

 I found an article in the American Jounal of Rheumatology on diagnosis and treatment of erosive inflammatory OA:
   https://www.the-rheumatologist.org/article/what-to-do-with-erosive-inflammatory-osteoarthritis/

I suggest you see if you can be referred to a hand therapy service, if they exist in your area, to give you advice on how best to manage this, whilst you are waiting for your steroid injection.

Thank you - that's a good idea - will do!

[lizzog]

The Consultant with whom I worked in the 1970s specialised in hand injury surgery.  I hated the Monday morning Clinics ........ 

tnx for the update.  Will those X-rays be available at the RA appt.?

They'll be made available to the person doing the steroid injection so they can see where to site it I believe.