Rheumatoid Arthritis

I am in a lot of pain. On a scale from 1 to 10 a 11 1/2. I am a 49 year old female. I have had pain in the past with my hands and knees but nothing like this. It has come on rather quickly. I have severe pain in the joints - my hand more severe than the rest. My joins swell, are red and warm, and I hurt so bad I don't want to move them because it just makes it worst. I have trouble with my knees whereas when I get up from a chair sometimes I can barely move. My hips hurt at night so much it is difficult to sleep. All of this pain is on the joints on both sides. So of-course my question is, is it possible this is RA? I have a Dr. appt. tomorrow with a general doctor. What should I know in talking with him and if he does suspect RA what should I be ready to have happen?

Thank you for any information.

Good Morning, I have read your message & completely understand what you are going through. I am 37 and have been going through similar symptoms for the past 2 1/2 years. My doctor told me I have fibromyalgia, but I think I have RA. My blood work has also been negative but I experience joint pain & swelling, bilaterally starting with my feet & has moved all around. Now it is in my shoulders & wrists & knuckles. Needless to say I am going for a second opinion. I do know you can have SERONEGATIVE RA for this is an option I am assuming for myself. I do know that Steroids do help me along with NSAIDS, and this is not found with fibromyalgia patients. Hank tight, but go ahead & get all of the lab work you need. Their are other conditions like lupus that can cause similar symptoms. Also, how do you respond to therapy with steroids, just curious? Take Care , PamelaO

Thank you for responding Pamela. My RA Factor was elevated so I have been referred to a specialist.

I hope you are able to have more answers and start feeling better. Keep me posted.

I have had an arthritis panel done in december 2006 and june 2007, neither showed elevated RF factors. My symptoms, however, have persisted. I have been refered to a rheumatologist, however he has been unable to see me during one of my flare ups. My most recent major one (other than the one I'm having right now), was so bad I went to the ER. My inflammation has been misdiagnosed as infections before, and this doctor yet again thought it was infection. He prescribed me steroids and antibiotics, but I only took the steroids as a diagnostic tool. And wouldn't you know, after 2 days on Prednisone the swelling was gone! A few months later though I found out I was no longer insured, so I have been unable to visit any doctor since. I currently have a small nodule on my left ankle, and a large one on my right shin. Both have been present for 3 weeks now. The one on my shin is very large, red, warm, and extremely painful to the touch. At times it also just throbs though without any contact. It has also caused swelling from the nodule location down through my ankle (I currently have a "cankle" I call it). For those of you diagnosed with RA, I was wondering if you experience nodules on the shins or other areas between the joints. I have heard of this happening, but don't know how common this is. I do know that I am in extreme pain, unable to visit a doctor until I get my new insurance in (hopefully) a week, and am going through all this suffering at only 23 years old. At this point I just want ANY diagnosis, and ruling out even just one thing I consider to be a step in the right direction. My general history is inflammatory nodules and swollen and painful joints on and off since June 2006 anywhere from my knees down to the tops of my feet. Any personal experiences that could shed some light either way on if it sounds like I do or don't have RA would be appreciated. Thank you for your time and support.

Good morning MIR. I have read your message & I understand you pain. What I have read is about 20% of RA patients get nodules. So this is possible for you. Also, is you joint pain symmetrical? I would definately find a new doctor. Something doesn't seem right. I have similar symptoms minus the nodules and warmth. I do have symmetrical joint pain & inflammation which is crippeling at times. The only thing that helps me is prednisone followed up my Mobic for a period of months. I am also seeking a second opinion. My doc tells me it is fibromyalgia, which 30% of RA patients also have. He will not consider any other symptom. You do not get imflammed joints, symmetrical with pain & get better on steroids or NSAIDS. This I know. Do you know if you had an ANA or a SED rate test also. If not, you need them done to detect any imflammation and to check for other symptom related disorders. Although, I really think your symptoms unfortunately sound like RA. Keep searching for the right answer and fill me in with any new info. I hope I have been of help. Sincerely, Pam

Thank you for your insight Pam. The one thing that doesn't seem to fit RA with me is the symmetry. I can get flares on either side at any given time, but usually not with the same thing on both sides concurrently. (I do currently have nodules on both sides, but not at the same locations). I looked up fibromyalgia and that doesn't seem to fit what I'm going through. My ailments are all from the knees down and I don't have tenderness in other areas. I am calling tomorrow and hopefully will be able to see rheumatologist early next week. Unfortunately there are only 2 specialists in my town, so if he isn't helpful I don't have very many options. But I do realize only one extra available opinion is better than none. I have my fingers crossed for any news next week, I will keep you posted.

Here's a look at it's progression over the past few days. Unfortunately these images don't capture the 3-d effect of how far it's sticking out. I have another pic showing from the ankles through the shins of both legs for comparison of the swelling, but it is on my work computer. I will post that tomorrow.

I have had JRA for most of my life and sometimes but bloodwork comes back "normal". It's a mystery. I also get the nodules but I never seem to have them when I see the doctor. You need to get kind of pushy about things. It really sounds like RA to me.I don't know what other tests are available but they really need to look into this.My SEDrate is always normal unless I have an infection. Best of luck.

OUCH! Boy that looks painful. It appears that your inflammed area is above our joint. Or is it on your joint? Can't really tell. An ANA test is a Antinuclear Antibody. It is used as an indicator of an autoimmune disorder. Some patients with RA have this indicator, but it usually is used to detect Lupus. Your SED rate is an imflammation marker. Of coarse, all of these have been negative for me. However, I have had one positive RF, mildly elevated. My Rheumie told me to re-check one week after steroid treatment & at a different lab. At that point, my RF was in normal range. Go figure, maybe it was because I was responding to treatment. Fortunately, my father is a physician & has been monitoring and treating my symptoms until my appointment with my second opinion at the Cleveland Clinic in March. At times I feel I am loosing my mind and that it is all in my head and that I can manage. But as soon as the pain sets in again, I am at ground zero trying to cope & hoping to finally get a diagnosis other than what I have been given, Fibromyalgia. I just don't want to be behind in treatment. Although I have been taking, Mobic twice a day and it is helping and I am going to attempt water therapy in March. I hope I can get a hold on this situation sooner than later, I just want my life back as best as I can.

Thank you for your input Cyndi.

Here's a look from yesterday comparing my legs.
The spot is on the front of my shin, about half way between my knee and ankle. As can be seen there, the swelling has spread down through my ankle and even on the top of my foot. Ibuprofen doesn't work, compression doesn't work, ice doesn't work. I know steroids would clear the swelling up in a matter of 2 days, but I don't want to take any without seeing a doctor. I called this morning and the earliest I can be seen is next Wednesday. Knowing my luck everything will have cleared up by Tuesday so yet again he'll have nothing important to see.

Pam I hope you get some answers soon, and are able to manage the pain and get your life back to as normal as possible.

Hi Cyndi, those pictures look a bit better than the earlier ones, but you still need to tell you doctor everything. Also, bring in those photos & tell him your chain of events from start to finish. The fact that your swelling & redness doesn't occur on your joints directly makes me question a bit if it is RA. But, it may be referred pain & swelling, maybe a neuropathy due to RA. Thank you for your concern also, I will get answers sooner or later, but basically I have diagnosed myself along with all of my family, friends & my doctor father. Also, remember, someone very wise told me, "It is your body & your pain, you deserve to find the answers no matter how many doctors it takes. Medicine is an art, not a science. No two doctors may have the same philosophy when it comes to their profession." Actually these words came from my father, who I believe is the best Internal Medicine doc around. Part of being a good Physician is listening to your patients. Don't give up! Keep me posted. Take Care, Pam

I think I have figured it out! Well actually my friend's dad did, who is a retired anesthesiologist. After reading this short summary of the condition, I am totally convinced this is what is afflicting me: Erythema Nodosum. One symptom in addition to it causing the nodules like I have is joint inflammation and pain. This easily explains my confusion with possible RA. Looks like the next step is to get a biopsy and try to determine the cause of it.
Here's more info on it:Wikipedia, WebMD

Wow, I would happen to agree with that diagnosis to a tee. Just don't forget to tell your doc everything and show him the photos, along with your presummed diagnosis. I feel very bad that you have had to go this alone. Your previous doc should have picked up on that one. Good luck with everything & please fill me in on your docrots appt. If for some chance he blows you off, please seek yet another opinion. Make sure again he checks for sarcoidosis. You'll need a chest x-ray & a specific blood test to show Sarcoidosis. The good thing is, this can be treated with aggressive steroids, and it may never come back. A good friend of mine had sarcoidosis a few years ago, so I'm up on that info a bit. Take care & keep in touch!, Pam

So I got a confirmation today that I do definitely have Erythema Nodosum. The detmatologist wasn't there so no biopsy, but my rheumatologist was convinced anyways. He believes I have it due to a medication I take, so I am stopping that and starting steroids (Prednisone) for the swelling, so we'll see how it responds to both of those. I got a chest x-ray and I appear to be clear of sarcoidosis which is good news. Now it's just back to the waiting game...
Wishing the best for everyone!

That is great. This is proof that self diagnosis can definately help. I wish you the best of luck in your recovery. Please keep me updated. Take Care! Pam