What Is The Difference Between Rheumatoid Arthritis And Hyper Uricemia?

Posted on Mon, 30 Dec 2013

Question: Hi, Hope you guys are well. I am 29, male, Indian. Let me start by putting out the data points: 1) I have joint pain. It changes its zone based on the day. Typical areas affected are - sides of the knee, under the feet, back of knee. 2) This joint pain has been going on since 2008. First started when I was traveling in Europe in teh Autumn-Winter of 2008. 3) Some history - my ASO Titre was very high when I was 14. This was when I went to the doc with a 'tic' which comes everytime I stretch or twist the elbow. Echo was taken which turned out normal. Doctor prescribed Peniciliin 800mg for about 3 months. Was advised to stop Penicillin after 3 months, even though ASO did not drop to normal. 4) In 2009, a Physician looking at my history diagnosed me with Rheumatic Arthritis (which I think is wrong) and asked me to go on 800mg Penicillin everyday. I have been taking this till last month. 5) Joint pain kept appearing - and I went to a rhematologist a month back. The doc diagnosed me with rheumatoid arthritis - which I think is possibly correct. I am now on Prednisolone 10mg in the morning and HCQS at night - for the last one month. My reports however dont point towards Rheumatoid arthritis explicitly. 6) As a reference check I went to a neighbourhood physician who looking at my reports diagnosed as Hyperuricemia - my Uric acid levels are high (just below the higher bar). He asked me to stop Prednisolone and asked me to go on Febuxostat. I have not stopped Prednisolone though and have not started Feb. Now I am confused between rheumatoid arthritis and hyper uricemia. Any advise will help? Thanks a lot, XXXXXXX

Answered by Dr. Dr. Praveen Tayal (7 hours later)

Brief Answer: Both the conditions may co-exist. Detailed Answer: Hello, Thanks for posting your query. The recurrent pain in the knee and the foot that you are having can be due to rheumatoid arthritis. It can be diagnosed based on the clinical symptoms even if RA factor is negative. But since you started taking prednisolone and HCQS, the symptoms should have improved. The raised levels of uric acid in the blood will add to the inflammation of the joints. You need to start taking the medicine- Febuxostat to increase the uric acid excretion from the body to bring back the levels for an early recovery. I hope this answers your query. In case you have additional questions or doubts, you can forward them to me, and I shall be glad to help you out. Wishing you good health. Regards. Dr. Praveen Tayal.

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Dr. Praveen Tayal (13 hours later)

Please find the relevant test reports attached

Answered by Dr. Dr. Praveen Tayal (3 minutes later)

Brief Answer: Continue Predisolone and start Febuxostat Detailed Answer: Hello, I have gone through all your reports in detail. The rise in Uric acid levels(not very high) is likely to be a cause of recurrent pains. I find that RA factor is undetectable in the report. The doctor would have diagnosed it as RA based on clinical criteria. Rheumatoid arthritis can also be a possible cause. As I said earlier, both of them can co-exist. You can start with Febuxostat and observe the response in two weeks. The dose of this medicine needs to be monitored regularly. Hence follow-ups are essential. Since Prednisolone alleviated your symptoms, you may continue with it. I would suggest that you redo the Serum Uric Acid levels again after two weeks. Hope my answer is helpful. If you do not have any clarifications, you can close the discussion and rate the answer. Wish you good health. Regards Dr. Praveen Tayal

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Praveen Tayal (22 hours later)

Dr Tayal, RA factor is negative. And there is nothing obvious in the report of rheumatoid arthritis. Is there a foolproof way to say yes/no on rheumatoid arthritis? I have not started on Febuxostat. I have been on Prednisolone for about a month now. Symptoms have reduced completely. Does symptom reduction due to Prednisolone indicate rheumatoid? I also have concerns on Prednisolone. Prednisolone is a cortico-steroid with high side effects. I have taken it for a month and might continue for a while on the drug. Any advise on this? Thanks for your advise. Also - what is the reason for high uric acid presence? RA I understand is genetic and could be induced due to smoking. Best, XXXXXXX

Answered by Dr. Dr. Praveen Tayal (8 hours later)

Brief Answer: There is definitive cause for RA. Detailed Answer: Hello again Mr. XXXXXXX I understand your frustration. I will answer your specific queries in order, 1. The straightforward answer is "NO". Improvement with Prednisolone cannot judge whether it is RA or not. Most of your tests are negative, except some moderate elevation of ESR and increased total WBC counts. But these are not specific for RA. Rheumatoid arthritis is diagnosed with the help of a scoring system called 2010 ACR Diagnostic Criteria which takes into account the clinic findings, lab findings, and patient self reported activity levels. There are many other tests that can be done to look for changes of rheumatoid arthritis like X-ray, MRI scan, Joint fluid aspiration, Sinovial biopsy to name a few, which can show the degenerative changes that may be present if it is rheumatoid arthritis. RA has no specific cause yet identified, it is a degenerative systemic disorder that may or may not have serological markers positive. This means, there two types of RA, 1. Seropositive RA, 2. Seronegative RA. You might have second variant and your doctor has judged it with clinical criteria. I don't find your uric acid levels to be elevated and concerning. The lab range which is given in the side clearly says for males the reference range is 3.5-7.2, your level is 6.5, which is just high normal. 2. Symptomatic improvement after prednisolone does not indicate that the condition is rheumatoid arthritis, it simply means that the inflammatory process which was going on is under control due to prednisolone. 3. Since you are very happy about Prednisone, you need not start on Febuxostat for now. I was only talking about trial therapy with Febuxostat for two weeks in my previous reply and retest serum uric acid levels. I was hoping if Febuxostat improves the condition. Since you are benefiting from prednisolone and HCQ, there is no need to start Febuxostat. Continue with prednisolone as per your rheumatologist's advice. It is only one month now and small dose. On follow up your rheumatologist will take a decision about tapering. You can gradually taper it off. I sincerely hope I have addressed all your concerns, however if you need further clarifications, you are most welcome to ask me for the same. In case you don't have any more questions and are satisfied, please close the query and review the answer. Wishing you good health. Best regards,

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Above answer was peer-reviewed by : Dr. Yogesh D