Rheumatoid Arthritis in a Patient with Knee and Wrist Swelling " Larry a 58-year-old gentleman"

Case study ( 5548 views as of February 23, 2024 )

Larry is a 58-year-old gentleman who has noticed that his right knee has become moderately swollen. It has been like this for about 3 months. He thought it was initially because he was working more hours as a mechanic. He tried taking some ibuprofen which helped partially to reduce the pain and the morning stiffness he was experiencing. About 1 month ago, he started getting pain and swelling in his wrists as well. Now his joint symptoms are starting to interfere with his very physically demanding occupation.

His family physician confirmed swelling of his right knee and his wrists and ordered some initial investigations. These showed an elevated blood marker for inflammation but negative tests for rheumatoid arthritis.

Larry is wondering if he actually does have rheumatoid arthritis because he tested negative for the rheumatoid factor. He wants to be able to get back to work as soon as possible.

Larry could benefit from further discussion with his family physician, and referrals to allied healthcare providers that could help his symptoms such as a rheumatologist, physiotherapist, bracing specialist and/or massage therapist.


Conversation based on: Rheumatoid Arthritis in a Patient with Knee and Wrist Swelling " Larry a 58-year-old gentleman"

Rheumatoid Arthritis in a Patient with Knee and Wrist Swelling " Larry a 58-year-old gentleman"

  • Giant cell arteritis (GCA), also known as temporal arteritis, is an important medical condition primarily affecting individuals over the age of 50, although it can occur in younger individuals as well. It is characterized by inflammation of the large vessels in the body, specifically those that supply blood from the heart to the head and arms. The symptoms of giant cell arteritis can vary and may initially be subtle. Common symptoms include fatigue, unexplained weight loss, general feelings of being unwell, and generalized aches and pains. A significant proportion of people with GCA experience notable discomfort and pain in the shoulder and pelvic areas, known as the shoulder girdle and pelvic girdle respectively. There are several key symptoms that are associated with giant cell arteritis. One of the more common features is a type of headache called temporal headache, which affects the temples on the side of the head. In fact, GCA is sometimes referred to as temporal arteritis due to the inflammation of the temporal artery. Another symptom is jaw claudication, which is pain or discomfort in the muscles of the jaw that occurs during chewing. It is important to note that the pain is not in the jaw itself but in the muscles of the jaw. A rare but serious complication of giant cell arteritis involves the artery supplying blood to the eye. This can lead to partial or complete visual loss in one eye, affecting about 10 percent of individuals with the disease. Losing vision in one eye increases the risk of vision loss in the other eye, which can result in complete blindness. Therefore, early and aggressive treatment is crucial to prevent such devastating outcomes. It is worth mentioning that about one-third of patients with polymyalgia rheumatica (PMR), a condition characterized by acute or severe pain in the neck, shoulders, and hip girdle, may go on to develop giant cell arteritis. Therefore, individuals presenting with PMR should be closely monitored for symptoms associated with GCA, such as headaches, jaw claudication, visual complaints, and other relevant symptoms. If you have any concerns or questions regarding the symptoms of giant cell arteritis, it is important to consult with your healthcare provider or a specialist who can provide appropriate evaluation and guidance.
  • Leflunomide is a medication commonly used to treat certain autoimmune conditions such as rheumatoid arthritis. While it can be effective in managing these conditions, it is important to be aware of the potential side effects associated with its use. One of the most common side effects of leflunomide is gastrointestinal issues, particularly diarrhea. To minimize these side effects, it is often recommended to start the medication at a low dose and gradually increase it as tolerated. Hair loss is another side effect that some individuals may experience while taking leflunomide. This side effect can be quite noticeable and may lead some patients to discontinue the medication. If hair loss becomes a concern, it is important to discuss it with your healthcare provider. Sores in the nose and mouth can also occur as a side effect of leflunomide. These can be uncomfortable, but they usually resolve once the medication is discontinued. Headaches are relatively common with leflunomide use, affecting up to 10% of individuals. If you experience persistent or severe headaches while taking leflunomide, it may be necessary to reduce the dosage or discontinue the medication. Leflunomide has been associated with rare cases of high blood pressure. If you have concerns about high blood pressure, it is important to monitor your blood pressure regularly while taking this medication. Your healthcare provider will typically perform baseline bloodwork before starting leflunomide and continue to monitor your liver and bone marrow function with regular blood tests every one to three months. In rare instances, leflunomide can cause inflammation of the lungs. If you develop symptoms such as cough, shortness of breath, or flu-like symptoms, it is important to stop the medication and notify your specialist immediately. If you have any questions or concerns about leflunomide or its side effects, it is recommended to contact your healthcare provider or specialist. They can provide you with specific guidance and address any issues you may be experiencing.
  • The most common joints affected by septic arthritis are the knee, hip, shoulder, elbow, wrist, and finger. Most often, only one joint is affected. Symptoms can occur a bit differently in each person, but common symptoms include:\nFever\nJoint pain\nJoint swelling\nThe symptoms of septic arthritis can look like other health conditions. Make sure you see your healthcare provider for a diagnosis.
  • Rheumatoid Arthritis is an autoimmune disease that attacks the joints, causing pain and inflammation. If you are interested in treatment for Rheumatoid Arthritis, seeing your Family Physician could help, as they may refer you to a Rheumatologist.
  • The case study indicates that the blood work showed "an elevated blood marker for inflammation but negative tests for rheumatoid arthritis". Would that be a standard blood test or something specifically to look for rheumatoid arthritis ?
  • I have been experiencing similar things and I am currently waiting to see a Rheumatologist. RA blood work has come back negative, but I showed elevated inflammation. I have had pain and swelling in both knees for years now, constant exhaustion, and just assumed it was from working on my feet. Swelling and pain has spread to both wrists, both hands, all fingers (pinky fingers are the worst and beginning to curve inward), both feet and occasionally the elbows and shoulders. The pain gets to the point where I cannot open door knobs or bags of chips. A 5 day trial of prednisone made 90% of the pain and morning stiffness go away. Coming off the prednisone, pain and stiffness returned. I have just been referred to a rheumatologist, but being in the northern community of Terrace, and no positive blood work for RA, it is unknown when / if I will get an official diagnosis, or relief. I am happy to have been referred to this Dr, as I have heard great things, and am ready to get on the path to feeling like a healthy 31 year old woman. This case study gives me hope that there may be relief in my future :)
    • @JKeys1984 I hope that the doctor can help you out and find out whether you really have rheumatoid arthritis
  • This was me for a good 10 years of my adult life. I had joint swelling, mostly my knees and was diagnosed with Rheumatoid Arthritis ( with no blood tests) Years later, I was diagnostic with Ankylosing Spondylitis, but my bloods show no markers. Finally, after having doctors and rheumatologists throw their hands in the air, I had many tests done, blood, MRI, knee taps. I was negative for all inflammation factors, yet I clearly had massive amounts of inflammation in my body. My diagnosis? Sero-negative inflammatory arthritis. It took a while for me to accept this strange disease. My rheumatologist got me started on methotrexate. It has been my lifesaver for the last few years. So much so, that I was able to complete a full marathon.
    • I'm glad you were finally able to get a diagnosis. It's my understanding that there are a lot of variables involved in treating rheumatoid arthritis so it can take a while to land on the right treatment. It sounds like sero negative inflammatory arthritis might be similar
    • Sound very difficult to endure and diagnose. I'm glad you finally got the correct diagnosis.
  • A friend has rheumatoid arthritis so bad her hands / fingers are starting to curl, is there anything that can be done to relieve her pain ?
    • My aunt has rheumatoid arthritis and was recently telling me that she has recently started getting injections in her hands that have provided her with increased mobility and less curling
    • Could physiotherapy help in addition to medication?
    • Your friend should definitely discuss drug therapies with her Rheumatologist. There are a number of drugs that can be used to treat rheumatoid arthritis
  • If he is a mechanic he is likely on his feet for the majority of the day. He might also want to look in to orthotics or some kind of shoe with extra support and cushioning.
  • My friend has been taking methotrexate for rheumatoid arthritis for several years. What are the risks with taking this drug long-term?
    • Romy, what side effects do you experience from taking Methotrexate once a week?
    • I have been on methotrexate for about 4 years now, on and off. On for 3 of those consectively. I was weaned off to see if it was having positive effects when ALL my joints decided to swell at once. I am on a low dose of Methotrexate , 10 mg/week, and I take it orally once a week. Yes, there are side effects, but they last about 15 hours, and I am asleep for 9 of them. My blood tests have been perfect and have been dropped down to once every 3 months. Until such time that my body is not reacting positively to methotrexate, is when I will look for another solution
    • There are many options of antibody treatment for RA. Some have different dosing regimes and side effects. A rheumatologist or pharmacist can go over the options best suited for that patient.
    • Humira is a biologic (an antibody drug). When used to treat rheumatoid arthritis, it addresses the inflammatory response in RA. There are several brands/drugs of the same class as Humira. Definitely explore all options with her rheumatologist.
    • Also I believe steroids are also used, are they something that can only be used short term because of their side effects?
    • Methotrexate is injected - My Mom is on this drug and takes it twice a week injected sub-q. It works by interrupting cell production (from my small amount of understanding) and helps stave off the arthritis. But there are many side effects, and long term affects from my understanding, there is a chance of liver damage, and damage to kidneys and lungs. She is considering Humira - I think it is the similar as Methotrexate.
  • This patient should continue to work with his doctor to discover why he is experiencing these issues. Given the frequent bending he could have worn ligament issues in his knee
  • Can you elaborate on the types of tests involved in diagnosing rheumatoid arthritis? Is there a genetic component to rheumatoid arthritis risk?
    • I would be interested in learning about testing for RA as well.
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