This is a positive rheumatoid factor. Rheumatoid factor is a protein that can be found in the blood. It is important to note that this is NOT specific for rheumatoid arthritis. Although, it can be present in RA and can be helpful in making the diagnosis of RA, rheumatoid factor can be present in other conditions as well, such as hepatitis C infection, endocarditis, and gammopathies (paraproteinemias). Your Rheumatologist will take a careful history and complete a physical exam to begin to understand why you have these symptoms and what process to attribute them to.
Unfortunately, the only clear treatment for PMR is corticosteroids. The good news is, this is generally in relatively low doses (less than 20mg). The use of steroid-sparing medications is under investigation, but so far there are no other approved therapies.
To answer your question, your doctor needs to determine what type of arthritis you have in your knees. If this is due to the most common form of arthritis, osteoarthritis, then treatment options include acetaminophen, NSAIDs, topical therapies, intra-articular injections, and physical therapy. If this is due to an inflammatory arthritis (such as rheumatoid arthritis or psoriatic arthritis) then treatment options include immunosuppressive agents such as methotrexate or biologics. Ultimately, if there is severe destruction, pain, and disability from either type of arthritis, knee replacement surgery can be an option.
Lupus is a diagnosis made by a constellation of symptoms, signs, and laboratory tests. Although the presence of autoantibodies, such as ANA and dsDNA are common in lupus, their presence alone is not sufficient to make a diagnosis.
Methotrexate is the cornerstone of treatment for RA and has demonstrated efficacy not only in treating the symptoms of RA but also to prevent the development of joint damage. Methotrexate does suppress the immune system, but serious infections with methotrexate are not common. Your rheumatologist will monitor you closely for any side effects associated with methotrexate such as liver test abnormalities, pneumonitis, or infections. Almost all autoimmune diseases require the immune system be suppressed to some degree, because ‘overactivity’ of the immune system is what drives the illness. It is always a balance between controlling the disease and not allowing for complications from the treatment. But that is where close follow up with your provider is key.
The treatment options of an ACUTE episode of gout, which is characterized by severe pain, swelling, and warmth of a joint include: NSAIDs (such as indomethacin), prednisone (oral), colchicine, or intra-articular injections of steroids. The choice of treatment depends on the individual. For example, patients with kidney problems cannot take NSAIDs. Oral prednisone may not be the best choice for a patient with diabetes, but an intra-articular injection may be sufficient. Allopurinol should never be started during an acute episode of gout. This is a uric acid lowering medication to be used in the long-term management of gout. However, if a patient is ON allopurinol already and has an acute flare, it can safely be continued.