Q: About a year ago my RA count was very high. My family doctor thought I had rheumatoid arthritis while an arthritis clinic physician thinks I have lupus. I show very little signs of either disease but am taking Plaquenil for lupus. Is there a way to definitely tell which one I have?
A: Sorry to hear that you are having these problems, but I am very glad that you are doing some investigative work to educate yourself.
It can be very difficult to diagnose these disorders because the blood markers that we have for them are non-specific. For instance, rheumatoid factor can be elevated in both conditions or can be elevated as a result of some other infection in the body that has nothing to do with either.
Both lupus and rheumatoid arthritis are autoimmune disorders which the body starts to attack its own connective tissue. Other closely related disorders are: Polymyositis-dermatomyositis (PM-DM), systemic sclerosis (SSc or scleroderma), Sjogren’s syndrome (SS) and various forms of vasculitis.
These diseases have a number of common features:
1. They affect women much more frequently than men.
2. They are “multisystem” diseases, capable of affecting the function of many organs.
3. They “overlap” with one another, sharing certain clinical symptoms, signs and laboratory abnormalities.
4. Blood vessels are the most common target of injury in all of these diseases.
5. The immune system is abnormal and accounts, at least in part, for the observed tissue damage.
Although lupus most often occurs alone, many people with lupus also have symptoms characteristic of one or more of the other connective tissue diseases. In this circumstance, a physician may use the term “overlap” to describe the illness. There are several well-recognized overlaps that may affect people with lupus.
In lupus, joint pain is common. Joint swelling may be present in some cases, but the majority of those with lupus experience joint pain without swelling or only intermittent swelling. In rheumatoid arthritis (RA), joint swelling is always present and pain is common but less prominent. If a person with lupus develops severe arthritis with joint deformities, he/she should be considered to have rheumatoid-like arthritis. In some instances, the physician might have reason to believe that both diseases–SLE and RA–have occurred in the same person. When arthritis develops in the course of lupus, treatment with non-steroidal anti-inflammatory drugs (NSAIDs), low doses of cortisone, and the antimalarial drug hydroxychloroquine (Plaquenil) are usually helpful. People with lupus who have typical rheumatoid arthritis are prescribed the standard forms of RA treatment. These include methotrexate, sulfasalazine and in some cases, more potent drugs to suppress joint inflammation.
Although we don’t have the definitive diagnosis in your case, the treatment for your joints would be the same regardless. It is important to continue to follow up with your doctors so that any potential damage to other organ systems can be caught early.
Dr. Brent Ridge is the health expert for Martha Stewart Living Omnimedia. You can call and ask him a question live every Tuesday at 2 p.m. Eastern on Sirius Satellite Radio, Channel 112 (1.866.675.6675). You can also follow along as he learns to grow his own food and raise goats on his farm in upstate New York by visiting www.beekman1802.com.
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