Sign-in to Ask A Doctor - 24x7
OR
Sign in with Google
Suggest Treatment For Tendonosis And Chronic Pain
Question: I have sero-negative polyarthritis with tendonosis in both shoulders and suspected Sjogren's Syndrome. Is it a leap to assume I have Rheumatoid Arthritis despite being sero-negative? I am on 400 mg Plaquenil daily and am still sore (yes I understand chronic pain will be with me), no remission in the 6 months I have been on the meds. Is this normal?
Brief Answer:
Is it Rheumatoid Arthritis.
Detailed Answer:
Good evening,
Thank you for writing on health care magic.
Well, it is possible to have Rheumatoid Arthritis despite being sero negative. But what I am confused here is with the diagnosis of Sjogren Syndrome. Sjogren syndrome can also cause arthritis which is quite intense, but it does not cause joint damage like Rheumatoid Arthritis.
Never the less, if your joint symptoms are quite intense, you need to be treated with a different medication, be it sero negative rheumatoid or Sjogrens. I would consider starting you on Methotrexate along with HCQS. HCQs is a very good drug but it s very mild when it comes to arthritis.
If you could answer my few questions, it will help me get insight on the problem you are facing:
1. Do you experience dry eyes or dry mouth?
2. Did they do the ANA and ENA test for you?
3. How high are your ESR and CRP?
4. What is the pattern of your joint involvement(large or small joints)? Do they accompany swelling?? Any early morning stiffness associated with it??
Do let me know these queries
Would be happy to guide you further
Regards
Dr Naval
Is it Rheumatoid Arthritis.
Detailed Answer:
Good evening,
Thank you for writing on health care magic.
Well, it is possible to have Rheumatoid Arthritis despite being sero negative. But what I am confused here is with the diagnosis of Sjogren Syndrome. Sjogren syndrome can also cause arthritis which is quite intense, but it does not cause joint damage like Rheumatoid Arthritis.
Never the less, if your joint symptoms are quite intense, you need to be treated with a different medication, be it sero negative rheumatoid or Sjogrens. I would consider starting you on Methotrexate along with HCQS. HCQs is a very good drug but it s very mild when it comes to arthritis.
If you could answer my few questions, it will help me get insight on the problem you are facing:
1. Do you experience dry eyes or dry mouth?
2. Did they do the ANA and ENA test for you?
3. How high are your ESR and CRP?
4. What is the pattern of your joint involvement(large or small joints)? Do they accompany swelling?? Any early morning stiffness associated with it??
Do let me know these queries
Would be happy to guide you further
Regards
Dr Naval
Above answer was peer-reviewed by :
Dr. Ashwin Bhandari
1. My eyes, mouth and nose are all dry. It has gotten so bad I have switched from contacts to glasses, no longer wear eye make-up and my optomotrist has sent a referral to someone in my city that specializes in Sjogren's - that appointment is not until March next year. I treat with eye lubricant, warm compresses, and frequent breaks from computer, reading work.
2. & 3. I unfortunately do not have my blood test results.
4. Joint involvement - presenting initially with hips, knees and feet. Swelling with all. Progression to include fingers, wrists elbows, shoulders, voice box. My Rheumatologist did sonography on hands and feet and showed synovitis in both. I am stiff in the mornings which can last more than a couple of hours. As the day goes on I get more pain. Once home and resting, stiffness is very bad upon rising. I can no longer sleep on my sides, only my back. My fingers are almost constantly swollen to nearly twice their normal size. I cannot wear rings as my fingers will swell over them (and quite frankly none fit anymore).
Symptoms started in November 2013, Plaquenil was started XXXXXXX 16th this year.
2. & 3. I unfortunately do not have my blood test results.
4. Joint involvement - presenting initially with hips, knees and feet. Swelling with all. Progression to include fingers, wrists elbows, shoulders, voice box. My Rheumatologist did sonography on hands and feet and showed synovitis in both. I am stiff in the mornings which can last more than a couple of hours. As the day goes on I get more pain. Once home and resting, stiffness is very bad upon rising. I can no longer sleep on my sides, only my back. My fingers are almost constantly swollen to nearly twice their normal size. I cannot wear rings as my fingers will swell over them (and quite frankly none fit anymore).
Symptoms started in November 2013, Plaquenil was started XXXXXXX 16th this year.
Brief Answer:
Sjogrens Syndrome
Detailed Answer:
Good evening
Thank you for answering the questions
Well you do have primary Sjogrens syndrome. As mentioned, it can cause severe arthritis as well which can be accompanied with joint pains ,swelling and early morning stiffness.
What i dont understand is, why only plaquenil? If you are experiencing such severe symptoms, you need to be given methotrexate along with short course of steroids. It will help relief your dry eyes and dry mouth a bit and joint pains will definately get better. I am not too sure how things go in canada, but you should consult another rheumatologist as one cant leave sjogrens syndrome untreated
Do let me know for more queries
would be happy to help out
PS: you dont need to be carrying pain all the time. You are gonna get better with the right treatment and lead as normal life as anyone
Regards
Dr Naval
Sjogrens Syndrome
Detailed Answer:
Good evening
Thank you for answering the questions
Well you do have primary Sjogrens syndrome. As mentioned, it can cause severe arthritis as well which can be accompanied with joint pains ,swelling and early morning stiffness.
What i dont understand is, why only plaquenil? If you are experiencing such severe symptoms, you need to be given methotrexate along with short course of steroids. It will help relief your dry eyes and dry mouth a bit and joint pains will definately get better. I am not too sure how things go in canada, but you should consult another rheumatologist as one cant leave sjogrens syndrome untreated
Do let me know for more queries
would be happy to help out
PS: you dont need to be carrying pain all the time. You are gonna get better with the right treatment and lead as normal life as anyone
Regards
Dr Naval
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Thank you Dr. Naval.
I am in the process of requesting to be referred to another Rheumatologist.
My family physician is frustrated as well as she also believes that Sjogrens is a large part of the problem. She has been supportive, has done all the testing except for the RA specific testing which is only ordered through a Rheumatologist.
Canada does have a "free" service for health care, but the price is generally lengthy delays in seeing specialists unless you are among those in the public eye, or have some sort of connection.
Thank you for your advice.
XXXXXXX
I am in the process of requesting to be referred to another Rheumatologist.
My family physician is frustrated as well as she also believes that Sjogrens is a large part of the problem. She has been supportive, has done all the testing except for the RA specific testing which is only ordered through a Rheumatologist.
Canada does have a "free" service for health care, but the price is generally lengthy delays in seeing specialists unless you are among those in the public eye, or have some sort of connection.
Thank you for your advice.
XXXXXXX
Brief Answer:
Primary Sjogrens & Diagnostics
Detailed Answer:
Good evening XXXXXXX
Oh well that s a bit hard. Here in XXXXXXX you can get things done within a week, blood tests appointments with few specialists and everything. .
Hope the information has been useful. Do consider talking to your rheumatologist or family physician if they can consider starting methotraxate or prednisolone till you meet you meet the specialist.
Feel free to ask me for more queries
Regards
Dr naval
Primary Sjogrens & Diagnostics
Detailed Answer:
Good evening XXXXXXX
Oh well that s a bit hard. Here in XXXXXXX you can get things done within a week, blood tests appointments with few specialists and everything. .
Hope the information has been useful. Do consider talking to your rheumatologist or family physician if they can consider starting methotraxate or prednisolone till you meet you meet the specialist.
Feel free to ask me for more queries
Regards
Dr naval
Note: For further information on diet changes to reduce allergy symptoms or to boost your immunity, Ask here.
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
Answered by
Get personalised answers from verified doctor in minutes across 80+ specialties
