I never knew there were different types of rheumatoid arthritis - refractory, palemdromic - until discovering this board. I've had two RDs and none have said I have a specific type. I'm quite confused. I tried googling but did not come up with much.
I also see that some of you get scans regularly. The only time I'm x-rayed or MRI'd is pre-surgical. Do I just have lousy RDs in my area? It's quite confusing.
According to my rheumatologist, rheumatoid arthritis IS a specific diagnosis. There are many types of arthritis and several rheumatoid diseases, and there and many, many overlapping conditions. Rheumatoid arthritis is rheumatoid arthritis; refractory means not responding to treatment. Palindromic rheumatism can, if not treated aggressively lead to RA: some physicians classify the condition as a subset of RA, others as a distinct disease.
[quote]Types of Arthritis: http://www.arthritis-treatment-and-relief.com/types-of-arthritis.html
The term arthritis is derived from the Greek: “arthron” meaning “joint” and “itis” meaning inflammation.
It refers to more than 100 different types of arthritis conditions such as rheumatoid arthritis, osteoarthritis, gout, pseudogout, psoriatic arthritis, and fibromyalgia to name a few.
Some of these conditions involve inflammation and others do not.
These 100 different conditions pose unique problems for diagnosis and treatment. [/quote]
http://arthritis.about.com/od/diseasesandconditions/Types_of_Arthritis_Rheumatic_Diseases_Related_Conditions.htm
http://www.arthritis.org/types-arthritis.php
>>THIS<< informative post may be of interest re: diagnostic criteria for RA.
[QUOTE=Spelunker]According to my rheumatologist, rheumatoid arthritis IS a specific diagnosis. There are many types of arthritis and several rheumatoid diseases, and there and many, many overlapping conditions. Rheumatoid arthritis is rheumatoid arthritis; refractory means not responding to treatment. Palindromic rheumatism can, if not treated aggressively lead to RA: some physicians classify the condition as a subset of RA, others as a distinct disease.
[quote]Types of Arthritis: http://www.arthritis-treatment-and-relief.com/types-of-arthritis.html
The term arthritis is derived from the Greek: “arthron” meaning “joint” and “itis” meaning inflammation.
It refers to more than 100 different types of arthritis conditions such as rheumatoid arthritis, osteoarthritis, gout, pseudogout, psoriatic arthritis, and fibromyalgia to name a few.
Some of these conditions involve inflammation and others do not.
These 100 different conditions pose unique problems for diagnosis and treatment. [/quote]
http://arthritis.about.com/od/diseasesandconditions/Types_of_Arthritis_Rheumatic_Diseases_Related_Conditions.htm
http://www.arthritis.org/types-arthritis.php
[/QUOTE]
Hi Green Tara, I agree with Spelunker's assessment, Rheumatoid Arthritis is a stand alone diagnosis. Palindromic,refractory and reactive are not types of RA.
There are actually three types of RA but they are assessed the severity of the RA and are not separate rheumatoid diseases.
There are only two type of inflammatory arthritis one is RA and the other is PA or Psoriatic arthritis. Sometimes patients do have both. PA patients flare exactly like we do but in addition to all the other symptoms they can also break out in Psoriasis. No fun at all. I know in the time after diagnosis, my rheumy was watching me to make an assessment about whether I was suffering from RA alone or PA or both. From memory, LinB has both RA and PA as well as Osteo arthritis because she is getting older. Triple whammy! Yuk!
Well i guess if your RD said you had RA that is a specific type. Ask him or her, I am sure he or she will let you know which type you have.
[QUOTE=Cordelia]
There are only two type of inflammatory arthritis one is RA and the other is PA or Psoriatic arthritis. [/QUOTE]
Hi Cordelia, nice to see you again.
My understanding of the types of inflammatory arthritis is, at least marginally, different: I took a quick Google Tour and found >>this<< list of "Other Types of Inflammatory Arthritis". The list includes spondyloarthropathies and reactive arthritis.
I thought, always a dangerous undertaking for me, that SLE, pseudogout, and the arthritis associated with IBS were also classified as "inflammatory arthritis".
However, I realize that very often different authorities list and/or contribute different diseases to what is or is not considered to be inflammatory arthritis. Many authorities list palindromic rheumatism as an inflammatory arthritis.
Opps, I have once again hijacked a topic...sorry. Returning, to the original question, rheumatoid arthritis is one of, in not the most, the common form of inflammatory arthritis. RA is a diagnosis in and of itself and does not require adjectives to qualify for a diagnosis.
Thank you so much for the clarifications. Ah, then refractory - not responding - is what I'm dealing with now. Over 10 years with RA and still so much to learn!
The confusion here as I see it is in the use of terms.
From what I understand there are different rheumatic diseases and auto immune diseases. The correct term for Palindromic is not 'arthritis' but rheumatism. Palindromic rheumatism.
I am not saying that there isn't inflammation involved here and Palindromic is a rheumatic disease.
From my research, and I could be wrong, there are only two types of 'inflammatory arthritis' with a stand alone diagnosis and that is RA and PA. Most people don't even know that PA exists.
So basic information I found said the following about reactive arthritis:
As for Refractory arthritis the information I found referred to it as antibiotic-refractory Lyme arthritis or Lyme arthritis. Again refractory can be cured evidently.Reactive Arthritis or REA is a condition that develops in response to an infection in another part of the body. Coming into contact with bacteria and developing an infection can trigger reactive arthritis. It has symptoms similar to various other conditions collectively known as "arthritis" such as rhematism. It is caused by another infection and is thus "reactive", i.e., dependent on the other condition. The "trigger" infection has often been cured or is in remission in chronic cases, thus making determination of the initial cause difficult.
Reactive arthritis (sometimes called Reiter syndrome) is inflammation of the joints and tendon attachments at the joints, often related to an infection.
Reactive arthritis is so called because the joint inflammation seems to be a reaction to an infection originating in the gastrointestinal or genitourinary tract.
There are two forms of reactive arthritis. One form seems to occur with sexually transmitted diseases, such as a chlamydial infection, and occurs most often in men aged 20 to 40. The other form usually follows an intestinal infection such as shigellosis, salmonellosis, or a Campylobacter infection. Most people who have these infections do not develop reactive arthritis. People who develop reactive arthritis after exposure to these infections seem to have a genetic predisposition to this type of reaction, related in part to the same gene found in people who have ankylosing spondylitis (see Joint Disorders: Ankylosing Spondylitis). There is some evidence that the chlamydia bacteria and possibly other bacteria actually spread to the joints, but the roles of the infection and the immune reaction to it are not clear.
Reactive arthritis may be accompanied by inflammation of the conjunctiva (see Conjunctival and Scleral Disorders: Introduction) and the mucous membranes (such as those of the mouth and genitals) and by a distinctive rash. This form of reactive arthritis previously was called Reiter syndrome.
Symptoms
Joint pain and inflammation may be mild or severe. Several joints are usually affected at once—especially the knees, toe joints, and areas where tendons are attached to bones, such as at the heels. Often, the large joints of the lower limbs are affected the most. Reactive arthritis often involves joints less symmetrically than rheumatoid arthritis. Tendons may be inflamed and painful. Back pain may occur, usually when the disease is severe.
... ...Rarely, heart and blood vessel complications (such as inflammation of the aorta), inflammation of the membranes covering the lungs, dysfunction of the aortic valve, and brain and spinal cord symptoms or peripheral nervous system (which includes all the nerves outside the brain and spinal cord) symptoms may develop.
In most people, the initial symptoms disappear in 3 or 4 months, but up to 50% of people experience recurring joint inflammation or other symptoms over several years. Joint and spinal deformities may develop if the symptoms persist or recur frequently. Some people who have reactive arthritis become permanently disabled.[/quote]
WHICH TREATMENT DO I NEED? — The type and sequence of drugs used to treat RA depends upon three factors: the activity, severity, and stage of rheumatoid arthritis.
Activity of rheumatoid arthritis — The activity of rheumatoid arthritis refers to the presence of joint swelling (inflammation). This can be measured with a combination of a physical examination, blood tests, severity of symptoms (pain, stiffness), and changes in the joints seen on x-ray.
Severity of rheumatoid arthritis — The severity of RA is based upon the severity of inflammation. Severity is classified as mild, moderate, or severe.
Mild — A person with mild RA has some of the following signs and symptoms:
Mild RA is usually treated initially with nonpharmacologic therapies and an NSAID. Only one NSAID is recommended at a time. This combination is continued only until inflammation has subsided.
If one or more joints remain swollen or tender after a few weeks of treatment with an NSAID, one or more DMARDs may be recommended, including methotrexate, hydroxychloroquine, or sulfasalazine. These medications are discussed in more detail in a separate topic review. (See "Patient information: Disease modifying antirheumatic drugs (DMARDs)").
Oral glucocorticoids (steroids) are not frequently recommended for people with mild RA. However, a glucocorticoid may be injected into a joint that is particularly painful; this can quickly reduce pain and swelling until the DMARDs begin to work.
More aggressive therapy is needed if rheumatoid arthritis remains active or progresses after three to six months of treatment with hydroxychloroquine and/or sulfasalazine. (See "Moderate" below").
Moderate — A person with moderate rheumatoid arthritis has a combination of the following signs and symptoms:
Moderate rheumatoid arthritis is initially treated with nonpharmacologic therapies, a high dose NSAID, and one or more DMARD. The choice of a DMARDs is based on the activity of the rheumatoid arthritis and the harm versus benefit of a particular drug for the individual. The choice is between hydroxychloroquine, sulfasalazine, and methotrexate. These medications may also be recommended in combination.
A clinician may also recommend short-term treatment with an oral steroid; this can relieve symptoms until the DMARD becomes effective. The steroid may be injected directly into one or a few joints to rapidly control inflammation and pain.
A biologic response modifier may be recommended if inflammation persists despite high doses of one or more DMARDs or if a person cannot take methotrexate. In this case, an anti-TNF agent, such as etanercept, adalimumab, or infliximab, is usually recommended, along with methotrexate (see "Biologic response modifiers" above). If one anti-TNF agent is ineffective or causes bothersome side effects, a second anti-TNF treatment may be tried. Alternately, another biologic agent, such as abatacept or rituximab, may be tried.
Severe — A person with severe rheumatoid arthritis has one or more of the following signs and symptoms:
Severe rheumatoid arthritis is initially treated with nonpharmacologic therapies and NSAIDs plus one or more of the DMARDs. The NSAID is usually discontinued after two to four weeks because NSAIDs have no long-term benefit in preventing destruction of a joint.
Methotrexate is the DMARD of choice; it is usually taken by mouth initially, and the dose may be increased as frequently as every week or two. As the dose is increased, the healthcare provider may recommend that methotrexate be injected under the skin (subcutaneous) or into a muscle (intramuscular) to minimize bothersome side effects such as upset stomach and sore mouth. A second and perhaps third DMARD may be recommended in addition to methotrexate.
Oral steroids may be added if there are symptoms of widespread inflammation, such as fever. The dose of the steroid is reduced as the person begins to improve; the goal is to take the lowest possible dose for the shortest period of time to minimize side effects (see "Steroids (glucocorticoids)" above).
A biologic response modifier may be recommended in people with severe disease who do not respond adequately to methotrexate. An anti-TNF agent, such as etanercept, adalimumab, or infliximab, are usually recommended first, along with methotrexate. If one anti-TNF treatment is ineffective or causes bothersome side effects, a second anti-TNF agent may be tried. Alternately, another biologic agent, such as abatacept or rituximab, may be tried.
Stage of rheumatoid arthritis — The stage of RA helps to determine which treatments are best. The stage is determined by the duration of the condition and the presence of inflammation. There are three stages: early, persistently active, and end-stage rheumatoid arthritis.
Early — A person with early RA has had evidence of inflammation for no more than six months. The treatment of early rheumatoid entails aggressive measures to slow or stop ongoing inflammation and protect the joints.
Persistently active — A person with persistently active RA has had evidence of inflammation for at least six to twelve months and may have irreversible joint damage and loss of function. The treatment of persistently active rheumatoid includes aggressive measures to slow or stop ongoing inflammation and measures to slow or prevent additional changes in joint structure and function.
End-stage — A person with end-stage RA has little or no evidence of ongoing inflammation but often has significant joint damage with deformity and loss of joint function. The treatment of end-stage rheumatoid arthritis entails therapies that reduce pain and slow or prevent additional changes in joint structure and function.[/quote]
Here's the diagnostic criteria from johns Hopkins for various arthropathies: