Possible RA now with UC

KK,

For what it is worth....

RA predominately affects the toes, fingers and wrists especially in early stages; more especially the knuckles and the middle joints of your hands. It is unusual for RA to affect the top knuckles (DIP) early on. RA rarely involves the back and so any presentation of back pain early on is usually an indication that another inflammatory process is present. Knee issues in RA tend to come later as RA usually manifests in the small pheripheral joints.

Your tendon and sole of feet issues (this is plantar) are enthesis; inflammation of the insertional points of the tendons to bones. Enthesis is seen almost exclusively in the SpA's such as psoriatic arthritis and IBD arthritis.

RA is very much about redness and swelling even early on as are most of the SpA's. Reactive arthritis and IBD arthritis have a propensity to present as an arthralgia without swelling since by their nature there is limited, if any, inflammation present with the immune system overreacting to another stimulus.

RA tends to be symmetric but early on this may not be as noticeable. The SpA's do not tend to be symmetric (especially not psoriatic arthritis) but it would not be unusual for a general polyathraglia to exhibit some form of symmetry. The SpA's will also have eye, nasal and even sinus issues whereas RA tends to not.

RA is biased to females by about a ratio of 3:1...there was a time when this ratio was believed to be 9:1 but less so nowadays with better diagnoses. The SpA's are more evenly distributed among gender.

But....your Rhemuy will still know best....as my GI will say...."the internet and health forums have not spent 10 years in med school'....he or she will know best.

When did you ger the steroid enemas and what was the prescription instruction?

q

So, Rheumatolgist appointment won't be until Spring 2022. (No date yet). Due to covid (almost 2 years), the visiting RA specialist from TO has a big backlog. I did leave my info if there is a cancellation (doubt that tho). 🙄

I did ask for a bit more bloodwork and xrays and pcp wants to check for Srogens syndrome also. I said to pcp, I want to establish a baseline so I can monitor and track what going on and whats working or not working. Did bloodwork today, waiting for xray dept to call for appt, hands feet and knees.

Also had optometrist appointment today, so doc knows and will follow up (every 6 months) especially if/when starting plaquenil. But if anything going on or changes, said to call and will fit me in. Glad for this

I still havent taken prescriptions, will decide to take if things get too difficult. Was thinking do steroids first then plaquenil? What a situation to be in. 😟 Geez, its hard to wrap my head around this but I am trying.

One positive note, the UC is not active at the moment 😒

Hi q
I did not know that it required a biopsy. Thank you for letting me know.

Post Edited (katkat) : 8/20/2021 8:18:19 PM (GMT-6)

Yesterdays bloodwork shows some results, numerous to write up atm but within reference range.

Total Bilirubin <2, (this is low), UMOL/L reference range should be between 3-17

Bilirubin glucuronidated (direct) 0.9 reference range should be between 0.00-3.9 with note specimen is lipemic

Results still pending for CRP and Anti-ENA screen.

What is AMA again?

What do you mean re usual suspects, flare and in relation to pred?

https://labtestsonline.org/tests/antimitochondrial-antibody-and-ama-m2

q

What dosge would you be starting at?

I cant advise you to take it or not. Since you were on it in the past, you would know what to expect.

Keep us updated what you decide.

q

You should ask your GP about LDN (low dose Naltrexone). AND CBD oil. Not vaping...the tincture.
q

I don't disagree with that reasoning, except that steroids aren't considered meds that alter the natural course of the disease like immunomodulators or biologics. They (steroids) are more like nuclear-powered NSAIDs.

Steroids are considered a powerful immunosuppressant at high doses. Granted continued use would create a ton of problems but the fact is they can be used as a bridge until a steroid sparing agent is started for better long term use.

See my comment on the other post....yes enthesis is a common feature of the SpAs.....see Stephen McGonagle on utube...an irish doctor in leeds who is the expert in this area.....actually the pathology of enthesis is beleived to be bio-mechanical in origin...i.e. a micro-tear happens at the insertion of the heal or the shoulder to the bone due to trauma but the immune system overreacts to this and cannot clear the inflammation stage.....ull find with insertional issues that they just fester sometimes for years without healing but without necessarily getting worse

Enthesis is therefore very common as a reactive symptom in IBD....an already overactive immune system latches on to maybe tiny micro-trauma in the heel or even the wrist and simply will not let go where the average non IBD person would not even notice the micro trauma and have the body clean it up within days....minimal if any swelling with enthesis in this form

Yes I agree on not letting this get out of control. In addition to the steroids prescribed, there is also 200 mg plaquenil. (1×/d). I am guessing these are the normal starting prescriptions for RA? Still havent taken either one yet. Plaquenil rx side effects pretty scary .

Still thinking if budesonide (2.3mg) entocort enema can be used as a bridge until pcp gets back to me about a lowering the dosage for the steroid. I left message earlier this week.

The UC is in good holding pattern for now, I don't want to get that activated. A follow up appt is scheduled for Feb 2022.

Hesitant on plaquenil and asacol mix for UC, did ask pcp, have to wait until next week for answer. Plaquenil not good for bowel diseases?

I asked pcp for a RA referral in MB which would be closer for me. They do take ON patients, they just need the referral. Hopefully can see RA soon.

I did lose 10 lbs since early July, was around 128 lbs before all this started. I think I am at point to use steroids to help stop this current roller coaster but just waiting for pcp call, if ok for lower dosage instead and shorter time? And no choice but to start plaquenil also. This can take up to 3 to 6 months to feel any effect on RA. In meantime it does affect the liver hence tests required every so often and opthamologist appts required also.

I don't wish these auto immune illnesses on anyone. ☹

Getting ready for vacation road trip. 😬

Sounds like you have low grade simmering inflammation of some sort. I'd paid no heed to the ENA test result whether it has been positive or negative. I'd actually pay no need to an ANA test result either; now that you already have a UC diagnosis these tests are far less interpretable than for a population without an overactive immune system. Those antibodies in your blood will now never change....you'll have them til your last day on earth!

Plaquenil is a good option for possible RA but my view is you need to begin high doze steroids to give it time to kick in and to modify the potential course of RA immediately. Yes all drugs have horrendous looking side effects but what is never listed is the probability of those side effects. Those who take Imuran for UC double their lymphoma risk....i.e. it increases from 1/5000 over lifetime to 2/5000 over lifetime. So it is doubled but 2/5000 is still a very small number.

Yes there are risks with meds. But you must live your life.