I just found this article on the
internet that may be of interest to others who are stuggling with a dx from the rhuemy, when symptoms are not textbook and you are in the early stages of suspected RA or have it mildly. (I also saw another article that mentioned using high resolution sonography instead of an MRI, which is more expensive to do as a screening)
What is Synovitis and Subclinical Synovitis?
About.com Health's Disease and Condition content is reviewed by Kate Grossman, MD
What is Synovitis?
Synovitis indicates inflammation in the lining of the joint, or
synovium. Synovitis is characterized on physical examination by
swelling, redness, and warmth.
What is Subclinical Synovitis?
Subclinical synovitis is inflammation of the lining of the joint that
is not found during a physical exam but patients may complain of joint
pain and prolonged morning stiffness.
Diagnosing and Treating Synovitis:
Newer techniques such as MRI scanning may detect subclinical synovitis.
The clinical significance of these MRI findings are unclear at this
time. In my experience as a rheumatologist, patients with subclinical
synovitis and normal measures of inflammation in the blood (erythrocyte
sedimentation rate or ESR, and C-reactive protein or CRP) are unlikely
to develop joint damage that shows up on basic X-rays, although I am
not aware of any published studies on this subject.
The important point is that there are patients with active rheumatoid
arthritis who do not have the typical swollen joints but may have
quality of life issues based on their symptoms, requiring treatment
including methotrexate and TNF blockers (i.e. Enbrel, Remicade, or
Humira).
Answers provided by Scott J. Zashin, M.D., clinical assistant professor
at University of Texas Southwestern Medical School, Division of
Rheumatology, in Dallas. Dr. Zashin is also an attending physician at
Presbyterian Hospitals of Dallas and Plano. He is a fellow of the
American College of Physicians and the American College of Rheumatology
and a member of the American Medical Association. Dr. Zashin is author
of Arthritis Without Pain - The Miracle of TNF Blockers. The book is
useful for anyone on one or considering the biologic drugs (Enbrel,
Remicade, Humira). Read our review of the book.
I saw this informative post on another board earlier, and I know it will be helpful to many.
This is OT of the thread, but I am just struck seeing it once again - the title of the book mentioned at the end: "Arthritis Without Pain - The Miracle of TNF Blockers". I know for most adults, pain is the biggest issue with the disease, but for children that isn't always the case. TNFs are presented to us as necessary for prevent future damage. So the miracle is hopefully more like "Without Arthritis".
Seeing a title like this makes me feel that really would be a miracle.
I found it. Here's more on using high resolution sonography:For my synovitis I didn;t need a confirmation of an MRI or anything. THey were as huge as golf balls on my hands and ripped my tendons to pieces. My hand surgeon is th eone who eventually sent me to my RD.
I can remember to this day after going to Dr. after Dr. asking what is wrong with my hands....walking into the hand surgeon's office and asking the receptionist to please look at my hands. THen the nurse came, then when the hand surgeon was done in an exam room he came to the receptionist window, looked at my hands and had me come right in...that is how bad they were.
I was delighted to finally find someone who could identify what these horrible huge soft balls were on my hands.
That was my experience.
jode
4 hand surgeries later I was in the RD's office. THen one surgery after the RD and dx.
THere are people out there that can help and the articles are such a big help. Finally some academics towards synovitis RA!!!!!!!!!!!!!!!!!
YES!
It has happened in my lifetime. COming from an era when absolutely no research was being done on this, you can see why I am so thrilled.
What a relief.
jode
So tell me, what is oligoarthritis?
I remember studying oligodendroglias but that is much different/ (also my favorite of all the terminology I had to learn in college).
Ok, I looked it up................
Oligoarthritis: Inflammation of four or fewer joints.
in the knee and ankle are involved. Less commonly, it can also include either the wrist or the elbow joint. The finger or hip joints may be affected but at a later stage. It is a slow and subtle form of juvenile arthritis and therefore the parents find it difficult to relate to the start of the disease.
jode
Thanks so much for these articles! Like Jode, I too have golf balls that are on my ankles but 3 years ago I did not present with standard RA symptoms. Maybe others won't have to go from Dr to Dr for a proper dx.
Jode - Did you have your golf balls surgically removed?
Happy Holidays Everyone!
[QUOTE=jodejjr]jode
[/QUOTE]
Sigh. This is what they like to think, after parents (um, moms) have spent months going to the doctor(s) saying something is wrong. When there is no pain, it doesn't get the doctors' attention.
My daughter's golf ball-size ankles lumps were said to be a ganglion cyst at first. Then, they were 'weird'. Even the ped rheum, after we were finally sent to one, said, "I'll have to look in my book to see what could have arthritis there." They are on the front, near the top of her feet, not in joint area where they examine for arthritis normally.
They went away a few months after she restarted zith. Came back (but not to the point she couldn't wear shoes again) when the dose was reduced, but I am happy to report one is gone and one is "feel-able" but not visible anymore as of this week.
"" They went away a few months after she restarted zith. ""
Exact with mine on my hands, they would reduce then fill right back up again, and painful!!! Oh my gosh.
Had them removed. Had my tendons rerouted on both hands and lost about 80% mobility of my right hand. I had to learn how to write and use my hand all over again, it took a couple years to do all this.
jode
Oh yeah, but in Michigan I do not qualify for disability...just in Indiana. Go figure.
jode
This is very interesting information! I've been so frustrated because each time I visit my RD, she doesn't see any redness, inflammation or feel any heat coming from my joints. (Although I still have painful and stiff joints and swelling in between visits!) Additionally, my labwork doesn't show anything significant. I'm still in pain and it impacts my life. My RD says I am a mystery to her. She is scheduling an MRI for me and I will be returning to her office in about 6 weeks or so. I hope the MRI of my feet shows inflammation or something. This is just ridiculous to me and I'm positive if I were to discontinue the MTX and Enbrel I would flare like a mother and my labs would come back screaming RA like they did in April before I began treatment!!
And now that I'm done ranting....
Hope everyone has a superfantastic and extra comfortable evening!
Pip
P.S. I hate the title of that book too, but for completely different reasons than most people.
Well maybe they will pay more attention to mri's now. As i had already had damage and swelling and surgery and took mri's to two RD's and could not get a dx. for anything more then fibromyalgia , I am sure i have fibro but the problem was i had more than fibro. I also wonder now with the anti-ccp if anyone with with this condition would show up on anti-ccp. I feel strongly that this test will change the misdx for future RA'ers getting a faster dx. It took about five weeks for test results to come back for anti-ccp. My ortho surgen had put a note on my mri report, shoulder swelling as i do not think this swelling is normal. Spine specialist said you have alot of arthritis out side of and around the spine, I do not know what is causing this. I do hope they can treat the future better than the past. My ortho insisted on the secound opinion he said he was sure it was RA and i had it everywhere. Well he tryed.And do not get me wrong i had some swelling that could be seen. It was usually gone in the three months or more time it took to get to the RD appiontment.