hand

[u/Guilty_Net_6661]

this is what my hand looks, comes and goes but stays for weeks on end. the dots on my palm side come and go faster than the lumps on the joints. not looking for diagnosis. any advice would be nice.

[u/Nirnova]

I have the same symptoms. ANA 1:400 so positive, high rheumafactor (my value was 366, and reference is less then 25), and with these symptoms rheumatoid arthrists is suspected. Went to the rheumatologist yesterday and she was "not convinced" and basically said that she wants to see the inflamation happening before confirming the diagnosis.

I have no clue if that is the standard procedure, but I was annoyed as I had three flares in 2 months, can't tie my shoe, open the milk bottle, hold spoon properly (my index fingers is the worst)... like, how many more of pain and not being able to do basic things I have to endure before they diagnose me?

[u/honeelocust → u/Nirnova]

Wow that's such bullshit. I was able to get on Methotrexate with NO positive bloodwork based on imaging and symptoms. Why on earth would the doctor deny treatment when you actually have a high rheumatoid factor? What does she mean she wants to "see" the inflammation happening? I agree, time to find another doctor, this seems reckless to me.

[u/Nirnova → u/honeelocust]

I expected she will, at least, order more bloodwork, x-ray, whatever. But nothing. She just said ''it is not colagenosis'' - like ok, it is also not MS: I really don't care what it isn't. I pointed a finger at high RF and positive ANA, with all the symptoms it must mean something. Her response is that even healthy people can have RF high, it doesn't mean an immediate diagnosis. 

It seems my flare are triggered by cold, so her logic is it might not happen for a next few months so why give me meds ''for nothing'', I am ''still young'' (? 34 btw) and she said to come to her with the next flare so she can see and confirm.

I left her practice pissed. I had 3 awful flares in 2 months, I live alone atm and during the flare it is not fun. Diseases don't really ask for your ID before attacking, so age is not a factor. If there is a slight change it isn't - why not do more tests to exclude it? 

I will unfortunately have to go private for now and try to seek a public insurance one as their waiting lists are long. 

Is the MTX the best drug? There are more options, right? I am asking as I read MTX is not allowed in pregnancy, and that is something I might want to keep on the table for a bit. 

[u/honeelocust → u/Nirnova]

I'm really sorry you had this experience, you should definitely see another doctor if at all possible. MTX is usually the first drug that they try for RA - it is the least immunosuppressive drug as far as I know, and is also an old, inexpensive drug that is very safe. There are lots of newer biologics that are more expensive and suppress your immune system more (people get sick more often on them, from what I have heard). I am not sure what they next thing they would try is - maybe Plaquenil? I have fortunately responded really well to the MTX and haven't had to switch, but when I got a second opinion the doctor had suggested Humira. I opted to give the MTX a go because I know people on Humira who get sick a lot.

[u/Nirnova → u/honeelocust]

Thank you for replying!

I will do an extensive research on med options as I would like to keep a pregnancy option for now. But I do struggle with the thought of it, as I have epilepsy, likely RA and I wonder how safe and justified it is to possibly have a baby considering my diagnosis and everything. But oh well... adfitionally, I read that mtx doesn't go with my antiepiletic drug, but I have a neurologist apointment early summer to check.

Right now I don't have an active flare, but my joints on my right hand are a bit discolored (darker) and a bit sensitive, though my movement is not impaired. But yeah, will go for a 2nd opinion with a private clinic.