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Diagnosis for Rheumatoid arthritis - Online Doctor Chats

Date : 13-Jan-2012
User rating for this question
Very Good Posted in: Arthritis
Answered by

General & Family Physician
Practicing since : 2005
Answered : 2253 Questions
User :   I have a history of JRA, which was apparently in a 6 year remisson, which has come out of remission 4 months ago, but now I am getting mixed results back. Female 22 years old.
User :   Hello?
Doctor :   Hi
Doctor :  
Let me read it
Doctor :   Ok

User :   I was wondering if an x-ray can be read incorrect, I had one recently done, back and hips, and it states I have osteoarthritis and degenerative disks or vertabrea L5 and S1
User :   Because I have a confirmed history of juvinile rheumatiod arthritis
User :   I am only 22 years old
Doctor :  
Ok, but X-ray does show the changes in Osteoarthritis
User :   it says it is osteoarthritis but I was told I have rheumatiod arthritis
Doctor :   Now for that doubt regarding the impression, you should take the report to another Orthopedic surgeon for a second opinion

User :   I am thinking of asking them to re read the x-ray and realize I am 22, with a history of rheumatiod arthritis
Doctor :  
Rheumatoid arthritis is diagnosed after bllod and imaging studies
Doctor :  
and not just with imaging studies
Doctor :   Yes, in rheumatoid arthritis, the changes are seen

Doctor :  
the surgeon has to keep that in mind while reading the image
User :   can thoes changes be misdiagnosed as osteo though
Doctor :  
and it is good to tell him to re read it with JRA in the back of his/her mind
User :   okay
User :   So next question
Doctor :   Yes, proceed

User :   Why would my blood work show positive XXXXXXXX for rheumatiod, indetermined (14) RH factor when anything above 14 is higher, I had an elevated set rate (ESR??) and now everything is negative and I am in the worse pain ever
Doctor :   Ok

User :   I mean anything above 14 is positive so i was boarder line
Doctor :   Meaning XXXXXXXX and Rh are negative now?
Doctor :   Ok

Doctor :  
I got it
Doctor :  
Are you on any medications right now?
User :   yes and the set rate is back to normal
User :   if you know what I mean by set rate
User :   it monitors active inflammation
User :   I went on methotrexate
User :   once a week injection 20 mg, with folic acid 5 mg
Doctor :   Ok

Doctor :  
Since you are on certain immunomodulators right now
Doctor :  
Your blood tests shall very as they are dependent on the immune levels
User :   Which is strange becaus eI know my immune system is low right now as I have many mouth sores, increased acne, and fatigue
Doctor :   Ok

User :   hmmm
Doctor :  
It does happen in weakened immune status
User :   but the blood work disagrees
Doctor :  
and is a result of drugs
Doctor :  
it does not disagree
User :   How can I be in the most pain ever and the blood work show normal
Doctor :  
You are taking it in the other way
User :   Usually they lined up
User :   so the blood work shows it is normal because of the drug
Doctor :  
Blood work showing normal, one of the possibilities is that the immune response is supressed with drugs
Doctor :  
and hence it is showing normal in the blood
User :   more pain = higher inflammation
User :   usually
Doctor :  
Doctor :  
But the response is not high
User :   you would think then the drug would be working and I would be in less pain
Doctor :  
as it has been kept under check by the drugs
Doctor :  
Pain is a symptom
Doctor :  
and cannot be taken in line with the severity of illness
Doctor :  
Are you getting it?
User :   urinalysis showed negative for everything
Doctor :   Ok

User :   So pretty much there is no answer to my back/hip pain
User :   what else can I have tested?
User :   I have had x-rays, blood work, urinalysis, physiotherapy, massage therapy
Doctor :   For that, you have seen the x-ray and does show inflammation

Doctor :  
but the blood test is not in line with it
User :   its only been 3 weeks, but unmanagable I am on oxycotin
User :   right
User :   correct
User :   the tests contradict them selves
Doctor :   Yes,
Doctor :  
but that is due to the effects of drugs and should be considered
Doctor :  
If you have further doubts, I would suggest you to consult our orthopedic surgeon
User :   I am waiting for that, 2 more weeks to wait with out appropriate pain management
Doctor :   Ok

Doctor :  
You can get a second opinion from our Specialist
User :   I might
Doctor :   Sure

Doctor :  
I shall give you the link
Doctor :  
WWW.WWWW.WW User :   can you think of a drug that manages pain but is not a narcotic
Doctor :   Copy paste the link in your browser
User :   and tylenol and ibuprofen do not work
Doctor :  
There are certain drugs like Tramadol, which have to be taken on prescription
User :   I am not allowed to work on narcotics
Doctor :  
Also for inflammation, Dicolfenac is beneficial
User :   Tramadol is a narcotic though
Doctor :  
You should speak to your doctor about it
User :   well I was hoping for ideas from you to ask him for
Doctor :   Yes Tramadol is a opioid

Doctor :  
but Diclofenac is not
Doctor :  
You can speak about that to your doctor
User :   I am looking for one that manages pain but is not a narcotic and not just anti-inflammatory, if there is such a thing
User :   okay
Doctor :   Yes, Dicolfenac is not a narcotic

Doctor :  
and helps in reducing the inflammation
Doctor :  
but cannot be used for a long term
User :   voltaren I know that drug
Doctor :   Yes

Doctor :  
It is very good for bone and joint pain
User :   okay thats a goof one, any others you can think of
User :   i was on meloxocam (not sure if that is spelt right) but it didn't work
User :   naproxin does not work
Doctor :   There is a similar one called Aceclofenac

User :   I mean a good one*
Doctor :  
Yes, Oxicam derivatives are not usually suggested
Doctor :   but remember that all these should be taken on prescription only

User :   i know
User :   I just want some ideas to talk to the walk in doctor on monday about
User :   so I can work and be in less pain
User :   celebrex I do not feel is suitable for me
Doctor :   Some of the steroid injections to the areas targeted specifically are also helpful

Doctor :  
if the pain is localised
User :   Maybe I would think you could not do that though for lower back pain
Doctor :   Yes not for lower back

User :   so thats out
Doctor :   So one more is Oxycodone
Doctor :  
which again is a codeine
Doctor :  
but should be discussed
User :   narcotic though
Doctor :  
as it is reserved for severe pain
Doctor :  
Yes codeine is
Doctor :  
But very strong
User :   as I said I am already on oxycotin :(
Doctor :  
and gives good amount of relief
User :   just as strong
User :   oh it relieves my pain fully I jut can't think on it or work on it
Doctor :  
Are you taking steroids as of now?
User :   nope
User :   a doctor did mention that though
Doctor :   Ok
User :   is that just to help boost the immune system?
Doctor :   No to supress the inflammation
Doctor :  
in the joints
User :   oh
Doctor :  
it does help but not instantly
Doctor :  
rather gradually
User :   hmmm
Doctor :  
and is safer compared to other analgesics

Doctor :  
Do try some of the Pain management techniques as well
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