Is this RA?

Question

I am a 38 year old female with fibromyalgia managed w/ rest, yoga, Cataflam (50 mg bid) and Celexa. One year ago I developed asymmetric joint & soft tissue pain, swelling & redness that was preceded by a GI infection. I also exhibited a low grade fever that would spike 2 times a day up to 101-102. The fever, pain & stiffness were unbearable. My family MD prescribed prednisone which helped immensely & sent me to a gastro to rule out Crohn’s. One month later my scope & biopsy returned no findings of Crohn’s. I was then referred to a rheumatologist to rule out reactive arthritis/AS. It took 2 months to see him & my symptoms had almost completely subsided by then. According to him, my tests were not indicative of a rheumatic process, HLA-B27 was negative & no involvement of the SI joints. He basically shrugged his shoulders, looked at me like I was crazy and gave a generic diagnosis of “poly-arthralgia”. He said it may have been reactive arthritis, but since my HLA-B27 was negative, it appeared to have resolved spontaneously & would likely not return. Now one year later, my fever, joint pain & swelling have returned in similar asymmetric pattern to previously affected & new joints. I recently moved across country, have a new family MD who has my history & records but is re-doing all tests and “watching to see what happens”. Meanwhile I am miserable and feel like my bad dream is back. What should I do? I do not want this to progress to how it was a year ago. Could I have RA or reactive?

Answer

Unfortunately, in this game, no one can diagnose what he or she doesn’t see and thus I can’t blame your prior rheumatologist for not making the diagnosis. It sounds like you may have a reactive arthritis and hopefully you’ll be able to see a rheumatologist when you have swollen joints for him or her to evaluate.

Alan Matsumoto, M.D.

About Alan Matsumoto, M.D.

Part-time Faculty, Division of Rheumatology
Johns Hopkins University