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Tendonitis & RA

This is such a confusing disease.  My ortho described it to me the other day in a way where I finally "got" it, sort of.  That the immune system latches on to healthy tissue, the white blood cells follow suit and attack and they are like acid that deterioriates the tissue.  Or something. Smile
 
ANYWAY, here's what I'm wondering:
RA in my had was first mis-dx as tendonitis.  MRI showed tendons not inflammed, just synovium, lots of effusions, def inflammatory arthritis--so the tendons are involved, but that's not the whole story.  Now my shoulder is doing the same thing.  Right now, it is just "rotator cuff tendonitis" according to ortho, but he also says it is related to RA.  I'm worried my shoulder will go the same route as my wrist (that is, get worse and worse and lose ROM).
 
I so don't understand this that I'm not even sure what question to ask.  How is it like tendonitis, but it's not?  Can anyone clarify?

Thanks!
Katie G the more I read the more confused I get. I don't think I'll ever understand this blasted RA.Ortho guys will usually dx based on a local symptom. They can see some issues if they MRI, but not everything. These need to be discussed with a rheum. Ortho folks generally don't want to venture into that area. The rheum will decide your best course of treatment to maintain your ROM.


Yeah, the ortho did the MRI on my wrist, and referred me to rheum, who made the dx and started my current course of treatment.  But he didn't have me doing PT and I kept forgetting to ask for a referral.  It was easier to get into the ortho (and they run their own PT--speaking of ethics--and are more than happy to refer to PT).  I was mainly concerned with the ROM on my wrist but my shoulder had been bugging me, and he dx as rotator cuff, but said it was because of RA.When I was first dx'ed many years ago I couldn't lift my arms above my head to brush my hair. It was so horrible! My first RD gave me cortisone injections in both shoulders and started the beginning of my RA treatment. The injections really helped.
 
You might want to consider it.
This confuses me also.  How are tendonitis and ra related?  Are they always related?

The ortho wanted to give me shots last visit.  But, I have a lot of pain (especially to the touch) but I can still get my arm above my head.  I can't straighten it all the way thought. Hopefully I will always be able to do so, but I figure I'll save the shots for when I get that bad.  Just increased MTX to 15 so hopefully that will stave this off, but it's developed while I've been on MTX, and I honestly wouldn't know I was on MTX.  Nothing has changed.  Just took my 8th dose, so it's been 2 months.  Guess we'll give it til 3, but hope to get on plaq. before then. I have an eye exam set up in a couple of weeks, preemtively!

I just recently went back on Humia after being off of it for a year due to some unrelated problems. I wasn't doing very well at the visit that we decided to restart the Humira. My RD gave me a synthedic (I think that's what it's called) cortisone injection. It was given in my hip but it helped all over. I had numerous places that were bothering me.
 
It made a huge difference in a matter of days.
 
 
Wow!  I have only ever had the one in my wrist.  It did help after a few days, but I still didn't get my full ROM back. 
 
I think I have a lot of inflammation that I don't notice, and slow loss of ROM.  I was looking at my shoulder in the mirror, and there are a few things I can do with my left but not my right, that I just noticed.  At least I have something to compare! Glad I am starting PT so someone can help me track things. 
 
I will probably talk w/ RD about shots soon!
RA also affects connective tissue. I had NASTY shoulder bursitis I put up with for over a year because I thought it was my rotator cuff (regular RA pain). I am not big on prednisone but my RD FINALLY figured it out to be the bursitis, gave me a dose pack and, BAM, fixed! All that time of suffering, not being able to lie on my side, on my back, on by stomach or SLEEP AT ALL. Couldn't raise my arms above shoulder height. I had chalked all my aches and pains up to RA. And, although RA affects the connective tissue sometimes it just take a small dose back to get the swelling down to make you feel SO MUCH BETTER. So check to see if it is bursitis. PT is another option for tendonitis and bursitis. As are those horrible cortisone shots.hi guys not sure what tendonitis is  but i do have a ruptured tendon
on my thumb .. just hangs down. done it in the first 3yrs of ra...
i looked on the web and heres a snippet..
Boney

n this factsheet:

The Facts on Tendinitis

Tendons are bands of tissue that anchor muscles to bones. They slide back and forth as our muscles contract and our joints flex. To prevent chafing and to keep them in position, the tendons are enclosed in special coverings (sheaths) that are lubricated. When something goes wrong that prevents the tendon from moving smoothly, pain and stiffness result.

When tendons are damaged and inflamed, the condition is commonly known as tendinitis. If the problem is in the lining of the tendon's sheath, it's called tenosynovitis.

Causes of Tendinitis

The most common causes of tendinitis are strain; overexertion; injury; repetitive movements; and sudden, unaccustomed movements. Tendinitis is most common in seniors and middle-aged people, since the tendons of older individuals lack the elasticity of younger people and have sustained hundreds of microscopic tears due to wear-and-tear over the years.

There are certain diseases that can cause tendinitis, such as rheumatoid arthritis, gout, Reiter's syndrome, lupus, and diabetes. Sometimes, people with gout have uric acid crystals that appear in the tendon sheath that cause friction and tearing. Very high blood cholesterol levels may also be linked with this condition.

Some common types of tendinitis include the following:

Rotator cuff tendinitis affects tennis players, swimmers, and anyone who frequently lifts their arms above the head and in a forward motion. This causes several shoulder tendons to rub together. Inflammation can set in and, if severe and untreated, may start to erode the tendons. Rotator cuff tendons hold the upper arm bone in the shoulder socket.

Achilles tendinitis involves the strongest tendon in the body, the one that connects the heel to the leg muscles. It's usually caused by running uphill or downhill, jumping, or engaging in sports that require sudden stopping and starting. Wearing shoes with either very soft-padded heels or very stiff soles, especially for someone whose ankles roll in, may also contribute to Achilles tendinitis.

Flexor digital tenosynovitis (trigger finger) may be seen in people with rheumatoid arthritis and diabetes. A protrusion or thickening of the tendon catches in the tendon sheath, causing the finger to bend and stick.

De Quervain's tenosynovitis (De Quervain's syndrome) affects the tendon sheaths extending from above the wrist to the thumb. The most common cause is excessive wringing of the wrist or other repetitive movements. In some cases, rheumatoid arthritis may be involved.

Symptoms and Complications of Tendinitis

The primary symptom of most types of tendinitis is pain. Some positions or movements can cause a greater degree of pain than others. You may also feel the lack of smoothness in the movement of the affected muscle. Sometimes, the tendon sheath fills with liquid and becomes inflamed. In other cases, it's dry and causes obvious friction when you move. In severe cases, tendons can rupture, causing increased pain and swelling and possibly permanent change in function of the respective muscle and joint.

Serious complications of tendinitis and tenosynovitis include muscle wasting and disability. The shoulder is the most vulnerable joint since it can freeze up, a condition called "frozen shoulder." In serious cases, the rotator cuff tendons can tear, which may lead to prolonged weakness and pain the shoulder.



Hi,
 
Flexor Tendonitis and Tenosynovitis are extremely common among individuals with RA, especially inflammatory RA.
 
It is speculated that individuals with higher titre RF are more prone to these conditions.
I am proof of this speculation.  Dx'd with inflammatory RA in 04/07 with  a RF of 1092, my disease mainly affects the tendons, sheaths and synovial tissue in my hands, wrists, knees and feet. 
 
You can get tons of info and treatment modalities relative to these conditions just by Googling the specific conditions, i.e. flexor tenosynovitis in RA.  Typing in 'Prevalence of Flexor Tenosynovitis in RA' will get you some good info also. 
 
Inflammation of the Synovium , FT's or both is quite painful in terms of ROM and can literally immobilize a person, preventing them from performing the most mundane of every day tasks.
 
My most recent episodes were in the FT's of both thumbs.  The slightest extension caused great pain.  Had injections of .05 Kenalog and although I just about went through the roof, within 72 hours, I had almost full ROM in my thumbs.  Same thing with two FT's in my foot.  Could barely walk and now completely cleared. 
 
Long acting, site specific corticosteroid injections have worked wonders in my particular case. I have yet to require re-injection in any site other than one wrist. Some of my injections were done over a year and a half ago and are still holding.
 
Study your disease.  Knowledge is power!
K.
Katalina2008-05-20 14:01:17Hi! RA causes a lot of conditions that appear internally and externally. I personally am on Humira and Methotrexate. I was on Remicade but was getting to many reactions during the infusion. I believe that the drugs help to reduce the inflammation that lead to tendonitis. I think reduce is the word to use because they don't cure it. I am quite active with yard work, golf, painting etc. but I usually pay the price mostly in my hands. This is corpal tunnel. I also get the pain in my elbows. Again, tendonitis. For the corpal tunnel I wear a wrist brace at times and when sleeping. Seems to help. I also get a cortizone shot in my wrist about once every four months or so. This helps the most, but I know this can cause other problems.
If anyone has any other ideas to relive corpal tunnel please let me know. Thanks Ed
hi edd i dont have carpal tunnel but i see others here who have..
maybe surgery is a option to disscuss whith your doc..

Boney     Thumbs%20Up

My first inkling that something was wrong was my left arm. I woke one morning and couldnt move my arm at all. The pain was horrendous. . It felt like someone hit me in the arm with a 2by4   I went to the ER and they did tests and sent me straight to a Rd . He said It was a flare and the area around the tenden was inflamed which causes all the pain. I have had many more instances since then and will never know how one is able to stand the pain we go through and remain sane. It has been many years and lots of pain and I think I'm still realativly sane only the lord knows why  Mello

 

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