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when to see a rheumatologist

When to see a rheumatologist

What Are The Early Signs Of Rheumatoid Arthritis?

October 30, 2019
What Are The Early Signs Of Rheumatoid Arthritis?

What are the early signs of rheumatoid arthritis? Rheumatoid arthritis is one of the more common forms of autoimmune arthritis, affecting about 1% of the adult population.  This may not seem quite common, but in the world of rheumatology this is actually quite common.  Women tend to be affected more than men 2-3:1 and the disease tend to manifest between the ages of 40 – 60.  However, it can also happen in young adults and older individuals.  When it happens in children, we call it juvenile idiopathic arthritis.

Early Signs of Rheumatoid Arthritis

The following are some of the early signs of rheumatoid arthritis.

#1 Inflammatory joint pain

Most of us experience joint pain at some point in our lives.  This is simply a part of being human.  However, most of us experience non-inflammatory joint pain NOT inflammatory joint pain.  Non-inflammatory joint pain typically worsens as the day progresses.  There typically is no swelling, redness, or warmth.  There can be stiffness but typically this last just a few minutes and certainly less than 30 min.  Basically, things quickly get better as you get going.

People that suffer from rheumatoid arthritis present with inflammatory joint pain, which presents very differently.

  • Joint pain that is worse in the morning and improves as the day goes by.
  • There is joint swelling and usually they feel warm.  At times they can look red.

People suffering from rheumatoid arthritis experience stiffness that usually lasts more than one hour.

#2 Involvement of knuckles, wrists, ankles, and toes

Although rheumatoid arthritis certainly affects larger joints, like the knees, hips, and shoulders, it tends to affect smaller joints like the knuckles, wrists, ankles, and toes.

#3 Symmetrical joint distribution

This is pretty self-explanatory.  Rheumatoid arthritis inflames joints symmetrically.  If the second knuckle on the right hand is inflamed, the second knuckle on the left hand most likely will be too.  Maybe not as much, but inflamed nonetheless.  However, it’s important to take this with a grain of salt, particularly early in disease.

#4 Fatigue

People often feel very tired, when they suffer from rheumatoid arthritis.  I’m talking can’t make it through the day tired.

#5 Fevers

This often depends on how quickly symptoms emerge.  Symptoms of rheumatoid arthritis usually develop over the course of months (55 – 65% of cases), but at times can develop over a few weeks (15 – 20%), and even days (10%).  The quicker the onset, the more likely someone will experience low grade fevers.  Some people, particularly those aged greater than 65 years, can present like polymyalgia rheumatica.  These people often present with fevers as well.

What Are Some Other Symptoms of Rheumatoid Arthritis?

Rheumatoid arthritis is a very complex autoimmune disease that can affect many different organs.  We discussed the 5 common early signs of the disease but the following are some other less common manifestations.

Cardiac

  • Pericarditis
  • Myocarditis
  • Coronary vasculitis

Dermatologic

  • Nodules
  • Skin vasculitis

Ocular

  • Scleritis
  • Episcleritis
  • Retinal nodules

Pulmonary

  • Pleuritis
  • Interstitial lung disease
  • Bronchiolitis obliterans
  • Lung nodules

Neuromuscular

  • Nerve entrapment – e.g., carpal tunnel syndrome
  • Neuropathy

Other

  • Severe dry eyes and dry mouth
  • Felty’s syndrome

What Are Some Of The Mimickers Of Rheumatoid Arthritis?

When faced with symptoms that look and sound like rheumatoid arthritis, it’s important to take a step back and consider alternative diagnoses.  Some of these include:

Next Steps

If you think you or one of your loved ones may be suffering from rheumatoid arthritis, I highly suggest you discuss your symptoms with your general practitioner or schedule as appointment with your local rheumatologist.  Although, signs and symptoms are very important, a good history and physical examination in conjunction with specialized bloodwork and x-rays, are essential to either rule in rheumatoid arthritis and rule out other possibilities.

References

Rheumatology Secrets 3rd edition

Medical Disclaimer

This information is offered to educate the general public. The information posted on this website does not replace professional medical advice, but for general information purposes only. There is no Doctor – Patient relationship established. We strongly advised you to speak with your medical professional if you have questions concerning your symptoms, diagnosis and treatment.

Diseases and Conditions When to see a rheumatologist

8 Warning signs of psoriatic arthritis

April 10, 2018

Most people think psoriasis is an autoimmune disease that only affects the skin, but did you know that about 26% of people also have psoriatic arthritis?  Did you know that psoriatic arthritis is more common than rheumatoid arthritis?[1]  What are the signs of psoriatic arthritis?

8 Warning signs of psoriatic arthritis

1.   Having nail psoriasis

A recent Japanese study tried to find risk factors that predispose people with psoriasis to develop psoriatic arthritis.  First, they found that about 17% of people with psoriasis also had psoriatic arthritis.   Furthermore, they found that people who had psoriasis involving their nails had a higher chance of having psoriatic arthritis: 29% (PsO) versus 62% (PsA).  In conclusion, they found that people who had high uric acid levels also had a higher risk of having psoriatic arthritis 9% (PsO) versus 22% (PsA).[2]

How does nail psoriasis look like?

Nail psoriasis can sometimes mimic nail fungus.  It can also make pits in the nail and can cause nails to break very easily.

Follow the link for examples.

2.   Having autoimmune joint pain

Autoimmune joint pain typically causes swelling and warmth of the joints.  People often describe stiffness that lasts more than one hour.  Symptoms are worse in the morning.  Furthermore, psoriatic arthritis can affect almost any joint: knuckles, toes, wrists, ankles, knees, etc.

3.   Inflammation involving the tips of your fingers

I’m referring to the tips of the fingers, also called the distal interphalangeal joints.  Osteoarthritis (i.e., wear and tear arthritis) in the hands can sometimes cause similar symptoms.  Typically, the symptoms in psoriatic arthritis happen more quickly and typically there is more swelling and redness.

4.   “Sausage fingers”

This happens when the tendons and ligaments that supply fingers get inflamed.  This can happen in a variety of different diseases such as ankylosing spondylitis, reactive arthritis, inflammatory bowel disease, infection, sickle cell anemia, sarcoidosis, and gout to name a few.  Follow the link to look at some examples.

5.   Having inflammation of tendons and ligaments

Enthesitis means inflammation of connective tissue that attaches to bones.  These include tendons, ligaments, and bursae.  Most cases of enthesitis are due to injury or overuse.  Think of a marathon runner with Achilles tendinitis or a tennis player with tennis elbow.  In psoriatic arthritis, the immune system attacks these connection points.  So you can have someone who leads a fairly sedentary life who suddenly develops Achilles tendinitis on both feet, runner’s knee, and plantar fasciitis happening all at once, for no good reason.

6.   Autoimmune back pain

Inflammation involving the back causes symptoms that are very different from your usual mechanical back pain.  Here are some key features:

  • Back pain present for more than three months.
  • Pain improves with exercise.
  • Pain improves with anti-inflammatory medications like naproxen or ibuprofen.
  • Rest usually worsens the pain.
  • Back pain that wakes you up during the second half of the night.
  • Pain and prolonged stiffness in the morning, typically lasting more than an hour.
  • Alternating deep buttock pain.

7.   History of uveitis

Uveitis is a general term used to describe a group of diseases that cause inflammation in the eye: uvea, lens, retina, optic nerve, and the vitreous.  Depending on where the inflammation is happening, your ophthalmologist may describe it as anterior uveitis, intermediate uveitis, posterior uveitis, or panuveitis.  As a result, people can experience blurry vision, eye pain, redness, sensitivity to light, and sometimes headaches.

Uveitis is associated with many diseases including psoriasis and psoriatic arthritis.  Sometimes uveitis is the first manifestation of psoriatic arthritis.  This is why I’ve included this topic here, even though technically it isn’t arthritis.  It’s important to keep this in the back of your mind.[3]  While uveitis is one of the signs of psoriatic arthritis, psoriatic arthritis is not the most common cause of uveitis.

8.   Having a first degree family member with psoriasis or psoriatic arthritis

This means mom, dad, siblings, and children.  Furthermore, other diseases also increase risk.  These include Crohn’s disease, ulcerative colitis, ankylosing spondylitis, reactive arthritis, and uveitis.

Call to action

In conclusion, if you think you may have psoriatic arthritis, I encourage you to contact a rheumatologist to get tested.  Time is of the essence.  Click on “FIND A RHEUMATOLOGIST” above to search the American College of Rheumatology database to find a rheumatologist near you.

Want to learn more?  The Arthritis Foundation and the Arthritis Society are also great starting points.

Medical Disclaimer

This information is offered to educate the general public. The information posted on this website does not replace professional medical advice, but for general information purposes only. There is no Doctor – Patient relationship established. We strongly advised you to speak with your medical professional if you have questions concerning your symptoms, diagnosis and treatment.

References

[1] Rheumatology Secrets, 3rd edition

[2] Tsuruta N, Imaguku S, Narisawa Y.  Hyperuricemia is an independent risk factor for psoriatic arthritis in psoriatic patients. J Dermatol. 2017 Jul 10. doi: 10.1111/1346-8138.13968. [Epub ahead of print]

[3] https://nei.nih.gov/health/uveitis/uveitis