Early diagosis of RA and treatment can help prevent damage, deformity and disability. Damage may occur as early as 6-12 months. Patients with RA due to chronic inflamamation are more likely to get secondary OA. This does not happen quickly and occurs over years.Finally, patients on biologics can get joint damage without symptoms if they have peristent joint swelling.I don't worry about this if I I have a patient on a biologic who has no pain or swelling and has a normal ESR and CRP. (blood tests for inflammation)View Thread
The most common cause of neck pain is muscular or osteoarthritis RA patients with neck pain tend to have prolonged AM stiffness in the neck for at least 45 minutes. Those without RA tend to find their pain is worse with activity and improved with rest.View Thread
In my patients with RA and localized activity, eg one joint. I will offer patients a steroid injection if there are no signs or symptoms of infection. In patients with active RA, I will maximize oral methotrexate to 20mg once weekly(assuming no contraindications) and then switch to injectable MTX if no benefit after 3 months which may be absorbed better. In patients with active RA who do not responde to plaquenil and methotrexate, I will add low dose sulfasalzine or change to a biolgic such as Humira or Enbrel.Some patients with RA may have a positive ANA but I always exlude Lupus as best as possible in my patients with a Positive ANA through additional blood work.View Thread
For the majority of my patients, I will use the TNF blockers Humira or Enbrel as my first biologic because patients can give it themselves at home and don't need to go to a clinic to get an as with Remicade. .I have the most experience with these two,(your insurance may dictate which they will pay for) You may enjoy reading my book, Arthritis without Pain. It was written a while back but it still has useful information about the TNF blockers. Newer TNF's that are now available include Cimzia and Simponi. They may be less likely to cause a burning sensation which may occur with the earlier released injections. Orencia is a different class of biologics that may be used as a first line drug. When adding a biologic, I will typically continue the MTX as up to 80 % of patients need combination therapy with a DMARD like MTX to achieve an optimal response.View Thread
For those patients I prescribe folinic acid (leucovorin), I tell them to take it 8-12 hours after their once a week MTX dose,, If they forget, it still may help to take it in the first 24 hours to help prevent MTX side effects such as fatigue, mouth ulcers, as well as other problems. .I also keep my patients on daily folic acid 1mg.View Thread
Unfortunately, I don't have expertise with this type of problem. Consider seeing a pediatric Rheumatologist if you have not done so Often they can be found at hospitals associated with medical schools.View Thread
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