When Two Autoimmune Conditions Share Similar Symptoms As Lupus And Rheumatoid Arthritis Do Diagnosing Them Can Be Challenging
Diagnosing autoimmune diseases can be difficult given that theres usually no one specific blood or imaging test to confirm the presence of them. And when two autoimmune conditions share similar symptoms as lupus and rheumatoid arthritis do rheumatologists sometimes face an added challenge.
If a patient has a more mild case of lupus and only the joints are affected, it can look like RA, says Sandeep Krishna Agarwal, MD, PhD, a rheumatologist, physician scientist, and an associate professor and section chief of the Section of Immunology, Allergy & Rheumatology at Baylor College of Medicine in Houston.
Both lupus and rheumatoid arthritis can cause joint pain, swelling, and stiffness. The joints most commonly affected the small ones in the fingers, wrists, knees, ankles, and toes are the same. The symptoms are typically symmetrical, which means that both wrists are affected, for example, rather than one or the other. People who have lupus or RA can also experience morning stiffness lasting for at least an hour.
People With Seronegative Ra Often Have Different Symptoms
The conventional wisdom is that seropositive patients have more severe symptoms, but recent studies suggest that the difference between the two forms of the disease may have more to do with the joints affected than with the severity of the RA symptoms. And a report published in June 2016 in BMC Musculoskeletal Disorders found that further research is needed to better understand the long-term outcomes of patients with seronegative RA. My experience has been that while the symptoms are similar, seronegative patients are more difficult to treat, says Vinicius Domingues, MD, a rheumatologist in Daytona Beach, Florida, and a medical adviser to CreakyJoints.
What Is Rheumatoid Factor
The immune system is an organized method through which the body fights off infections caused by bacteria, viruses and other organisms. A normal immune response to infection often involves the production of proteins such as antibodies to kill these invading organisms.
Sometimes, however, certain antibodies produced by the immune system may attack healthy proteins. In other words, the antibodies turn against the persons body damaging their health in the process.
When this occurs, the immune response that is triggered may result in what we now know as an autoimmune disorder. A variety of conditions have been shown to occur from these autoimmune responses.
Rheumatoid factor is one of many antibodies that are known to attack healthy tissue through an autoimmune process. When triggered, rheumatoid factor antibodies attack the healthy tissue resulting in a variety of symptoms.
Typically, these symptoms cause inflammation in the synovium a layer of soft tissue on the inner surface of joints, eventually leading to rheumatoid arthritis. Rheumatoid factor can also cause other symptoms seen in autoimmune disorders like Sjogrens Syndrome.
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After An Initial Diagnosis And Flare 11 Years Ago She Was Re
People whose illness began with severe symptoms were admitted to hospital as inpatients and given different treatments. One woman was admitted by ambulance. Two had fluid aspirated from the knees and one later had the joint injected and the leg put in plaster. Several people were admitted for bed rest either straight away or within a few weeks of being diagnosed. A woman with undiagnosed groin pain was given traction for 2 weeks. This type of bed rest and immobilisation of joints is know not to be best practice now and keeping joints moving is advised where possible. In fact exercise, appropriately paced, is a useful addition to the treatment of RA.
How Is Ra Treated
RA can be effectively treated and managed with medication and self-management strategies. Treatment for RA usually includes the use of medications that slow disease and prevent joint deformity, called disease-modifying antirheumatic drugs biological response modifiers are medications that are an effective second-line treatment. In addition to medications, people can manage their RA with self-management strategies proven to reduce pain and disability, allowing them to pursue the activities important to them. People with RA can relieve pain and improve joint function by learning to use five simple and effective arthritis management strategies.
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Has Monthly Blood Monitoring But It Is Difficult To Get A Sample She Likes To Know And
Most people understood what the blood tests were for: to ensure the liver and kidneys were functioning properly to check the red blood cell/haemoglobin levels to test for anaemia to ensure there weren’t excessive white blood cells and to measure the Erythrocyte Sedimentation Rate and C-reactive protein which indicate the level of inflammation and disease activity. Several people commented that the ESR value reflected how they felt.If results were abnormal, patients were notified promptly and asked to stop taking the particular medication likely to be causing the problem and have further tests. Two people were found to have anaemia and were prescribed iron tablets. People had record charts of their blood results and were responsible for taking them to both the GP and rheumatologist as part of ‘Shared Care’ arrangements.
Occasionally, people may need further investigations if problems occur such as abnormal blood results, bleeding or if an ulcer is suspected. An endoscopy may be performed’ a small camera on a long tube is passed down the gullet into the stomach , or similarly colonoscopy, where a camera is passed on a tube though the rectum into the bowel. These can identify problems with the digestive system. Three people had experienced one or both of these procedures. Two were reassured that there were no significant problems, but in one man bacteria were found which were causing his stomach problems.
Lupus Can Cause Kidney Problems
The presence of kidney-related symptoms can really set lupus from RA because the kidneys usually arent directly affected by RA. Signs of kidney involvement include swollen ankles and excessive bubbles in the urine.
In severe cases of lupus, the brain may also be affected, which can cause mental fogginess, confusion, memory loss, and even stroke.
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Distinguishing Between Osteoarthrosis & Rheumatoid Arthritis
There are several ways to distinguish between osteoarthritis and rheumatoid arthritis. The most common way to distinguish rheumatoid arthritis from other forms of arthritis is by using an X-Ray.
These two conditions can be easily diagnosed with a clear history, but X-ray, MRI and blood tests can be used to confirm the diagnosis. Deterioration of joints, lack of cartilage and spurs can be seen on a radiograph of a patient with osteoarthritis. ESR, CPR, anti-CPC can be increased in rheumatoid arthritis while there will be no changes in osteoarthritis.
Measures To Reduce Bone Loss
Inflammatory conditions such as rheumatoid arthritis can cause bone loss, which can lead to osteoporosis. The use of prednisone further increases the risk of bone loss, especially in postmenopausal women.
You can do the following to help minimize the bone loss associated with steroid therapy:
- Use the lowest possible dose of glucocorticoids for the shortest possible time, when possible, to minimize bone loss.
- Get an adequate amount of calcium and vitamin D, either in the diet or by taking supplements.
- Use medications that can reduce bone loss, including that which is caused by glucocorticoids.
- Control rheumatoid arthritis itself with appropriate medications prescribed by your doctor.
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How Do I Know If I Have Rheumatoid Arthritis Or Osteoarthritis
Arthritis can be regarded as a type of joint inflammation. Both osteoporosis and rheumatoid arthritis attack the musculoskeletal tissues in various ways. Currently, these diseases are common and it is necessary to have a quick intervention to minimize hampering of daily life quality. While rheumatoid arthritis is a kind of autoimmune disease, osteoarthritis can be regarded as a degenerative disorder.
Assessing Your Physical Ability
If you have been diagnosed with rheumatoid arthritis, your specialist will do an assessment to see how well you’re coping with everyday tasks.
You may be asked to fill in a questionnaire on how well you can do things like dress, walk and eat, and how good your grip strength is.
This assessment may be repeated after your treatment, to see if you have made any improvements.
Further information
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He Finds It Interesting To See The Progression Of The Ra By Having Regular X
X-rays taken as part of a rheumatology clinic visit often meant additional waiting as the rheumatologist wanted to see the new x-rays.One woman was dissatisfied with the service from one hospital as they did not regularly carry out blood tests or x-rays. When she moved to another hospital her joint x-rays showed deterioration requiring several joint replacements.
Bone mineral density scans may be performed to assess bone strength, particularly for people on long-term corticosteroids as these affect calcium absorption, bone growth and maintenance, potentially causing osteoporosis. Several people had been scanned and found these tests straightforward, not unpleasant, and enabled them to take action if necessary. If bones are weak increasing calcium intake and weight bearing exercise can help. Magnetic Resonance Imaging can identify soft tissue problems as well as bone changes. This was used to examine one woman’s shoulder and foot, another’s back and assess one man’s stomach problems. One man had an emergency MRI after developing breathing problems which the doctors could then diagnose as double pneumonia connected with his RA.Most people felt claustrophobic in the MRI machine and did not like the experience but appreciated it was a very good way of diagnosing a problem. A woman who was awaiting an MRI scan was worried her metal elbow replacements might be magnetic and wanted to alert the operator beforehand.
Last reviewed August 2016.
Rheumatoid Arthritis Initial Diagnosis
There is no single test that can definitively diagnose RA.
As with other illnesses, diagnosis of RA typically begins with your doctor getting your medical history and conducting a physical exam.
You doctor will begin by asking questions about the symptoms you’re experiencing, including when and how they occur and how they’ve changed over time . One specific symptom they will ask about is morning joint stiffness that lasts for at least 30 minutes and occurs in the peripheral joints rather than the lower back a common RA symptom.
The other main symptom is swelling of the joints that lasts for at least six weeks, particularly if the swelling occurs on the same joints on both sides of the body. Swelling that occurs for less than six weeks could be a sign of multiple different things an example is acute viral polyarthritis, an inflammation of the joints caused by a virus.
Arthritis Care & ResearchAutoimmunity Reviews
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What Are The Risks Of This Test
The rheumatoid factor test is very simple and does not generally pose any risks. You may have little bruising or pain in the area of the puncture site, but it will go away quickly. Complications are very rare, but some people may experience some side effects such as: Bleeding from the puncture site. Bruising at the site of puncture In rare case, infection at the site of needle insertion Some individuals may get anxious during the procedure and experience fainting or slight dizziness while the blood is withdrawn. In such cases, they should inform the technician or the health care provider taking the blood.The veins may also vary in size. In some people, the veins are not easy to find and the technician might have difficulty drawing the blood. In rare cases, an infection can occur at the puncture site. Patients must immediately report that to their doctor who may prescribe some medications for relief of the symptoms.
How Is Rheumatoid Arthritis Treated
The goals of rheumatoid arthritis treatment are to:
- Control a patient’s signs and symptoms.
- Prevent joint damage.
- Maintain the patients quality of life and ability to function.
Joint damage generally occurs within the first two years of diagnosis, so it is important to diagnose and treat rheumatoid arthritis in the window of opportunity to prevent long-term consequences.
Treatments for rheumatoid arthritis include medications, rest, exercise, physical therapy/occupational therapy, and surgery to correct damage to the joint.
The type of treatment will depend on several factors, including the person’s age, overall health, medical history, and the severity of the arthritis.
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The Doctor Knows Best
Its important to remember that like most diseases, RA affects each person differently. However, if you have the most common symptoms of rheumatoid arthritisongoing joint pain and stiffness affecting both sides of the body, symptoms that last several hours each morning, and nodules under the skin around the elbowsdiscuss them with your doctor to get an accurate diagnosis and form a treatment plan.
What Is Rheumatoid Arthritis
Similar to other autoimmune conditions, rheumatoid arthritis causes your immune system to attack the healthy tissues and cells in your body. Although RA usually damages the joints, it can affect other parts of the body, such as the eyes, heart, or lungs. RA can cause inflammation in joints located in the wrists, hands, knees, and ankles.
Symptoms can vary from person to person, but some early signs of RA include pain and tenderness in the joints. Over time, symptoms may get worse and progress to redness, stiffness, and swelling in the joints. Some people also have a low-grade fever and fatigue.
The exact cause of RA is not known, but several factors increase the risk of having this disease. It occurs more often in older adults and women. Smoking and being overweight also raise the risk of having RA. Certain genes have been linked to a higher chance of developing RA.
Illustration by Verywell
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You Cannot Smoke Not Even Socially
When it comes to RA, smoking has been shown to increase your risk of both getting arthritis in the first place and worsen your symptoms after you have it. This makes smoking one of the biggest risks for patients, Dr. Martin says. If youre serious about managing your RA you have to quit smoking. This includes even a social cigarette here and there.
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The Role Of Imaging Tests
Imaging tests such as X-rays can be very helpful in determining the correct diagnosis of lupus vs. rheumatoid arthritis.
This is because lupus, unlike RA, rarely causes joint erosions. Your doctor may also order a chest X-ray if youre experiencing symptoms such as shortness of breath that could indicate lupus urine and blood tests can show whether your kidneys have been affected.
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Seronegative Ra Could Become Seropositive Down The Road
Your rheumatoid arthritis markers may change over time from negative to positive, since many people with seronegative rheumatoid arthritis begin to develop RF or ACPA antibodies. It happens, but its not that common, says Dr. Domingues. Dr. Cush says people with seronegative rheumatoid arthritis may start to develop RF or ACPA within the first two years of diagnosis.
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What Do Rheumatoid Factor Test Results Mean
Testing positive for rheumatoid does not necessarily mean the patient has rheumatoid arthritis. A positive for rheumatoid factor test results means that it can lead to or is the cause of inflammatory symptoms from an autoimmune disorder.
In certain cases, however, patients may test positive for rheumatoid factor, yet remain healthy and never experience any obvious symptoms.
Rheumatoid factor can be present in patients several months or even years before clinical rheumatoid arthritis symptoms develop. Depending on the level of symptoms a patient exhibits, the rheumatoid factor test results can assist doctors in reaching a rheumatoid arthritis diagnosis.
Positive rheumatoid factor results in someone who has been clinically diagnosed with rheumatoid arthritis may also indicate the potential for a more aggressive disease course. This is possible in both children and adult patients.
Patients who test negative for rheumatoid factor but still exhibit symptoms and meet other diagnostic criteria may still be diagnosed with rheumatoid arthritis.
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How Do I Know If I Have Rheumatoid Arthritis
Still wondering how you will know for sure if you have rheumatoid arthritis? Arthritis is such a common disease that if you have one or several of the symptoms above, lasting for six weeks or longer, your chance of a rheumatoid arthritis diagnosis is high. To know for absolute certain, your primary physician, orthopedic doctor, or rheumatologist will conduct a series of tests to find out. Below are a few common options:
They Ask About Other Symptoms
Although symmetrical joint pain and swelling are the hallmarks of rheumatoid arthritis, its a full-body disease that can cause full-body symptoms. Sometimes, people experience loss of appetite, exhaustion, low-grade fever, and even nerve damage, says Dr. Cohen. Neuropathymuscle weakness, numbness, or a pins-and-needles sensationmay be another clue RA is the culprit. Osteoarthritis, on the other hand, is much more of a localized condition.
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