Adventures in RA Complications

I’ve been with my new rheumatologist for less than two years now. In that time, I’ve gone from near remission with stable disease to experiencing some of the extra-articular effects of rheumatoid arthritis (RA). Routine doctor appointments that used to be boring have become a bit more complex. My doctor and I even considered lowering my dose of methotrexate because things were going so well.

RA inflammation affecting more than joints

RA is a systemic inflammatory disease that commonly affects the joints. But it can also affect other parts of the body, such as the lungs, heart, skin, eyes, gastrointestinal tract, tendons, and more. Problems with these other organs are examples of extra-articular manifestations of RA. In short, extra-articular simply means outside of the joints.

However, over the past year, I have developed episcleritis (twice), increased symptoms of Raynaud’s syndrome (that prompted investigation for lupus), increased respiratory illnesses (the most recent occurrence lasting two fully months), an increased heart murmur, recurrent cough, and difficulty breathing (chest tightness and wheezing) when walking long distances.

Extra-articular RA symptoms

I had a routine 6-month appointment with my rheumatologist this week. During that visit so much happened that it was a minor whirlwind of activity. I reported being sick for all of May and June; and we recalled that I had been sick during the early - and mid-winter months as well. She ordered laboratory tests to check my immune system and is delaying my next dose of Rituxan. Depending upon the test results, she suggested the possibility of sending me to an immunologist.

As I discussed the excess coughing and problems with chest tightness and wheezing, my doctor has referred me to a pulmonologist for evaluation. I need to find one in my insurance network and call to make an appointment.

I also mentioned that my right knee was bothering me. It’s felt swollen, painful, stiff, and grind-y since Rob and I participated in the BikeMS Ride in June. I’ve been trying to take care of it at home, but the condition was not improving. My doctor offered a steroid injection which I accepted in attempt to reduce the inflammation.

My doctor also requested updated x-rays of my hands, feet, and knees. I haven’t seen the full report yet, but the unofficial summary from the office is “lots of [osteo]arthritis” in my knees. I got copies of the images before leaving the radiology office. On several views of my knees, large osteophytes (i.e., bone spurs) are quite visible. I know that sometime in the future, I will need knee replacement surgery, but I’d like to delay that as long as possible.

The final issue we discussed is a change in my methotrexate. I’ve been using oral methotrexate for over 10 years, ever since diagnosis. We are switching to the injectable form so that more of the medication can make it into my system, and hopefully be more effective. I received my first injection of methotrexate in the office.

When I went to fill the new prescription at the pharmacy, I discovered that injectable methotrexate is supplied in vials of various sizes, prepared either with or without preservative. The vials I received are preservative-free with 2mL of liquid containing 50mg of medication. My dose is 25mg/mL. Consequently, I have to throw away half of the medication each week. I’m glad that I talked to the pharmacist, because I would have used half of a vial one week and saved the rest for the following week.

So a lot of different things are going on right now and my RA is no longer a dormant, boring part of my life. I’m not too thrilled about that but have chosen to remind myself that I am a strong person who is capable of facing many challenges in life. Hopefully we can get things back on a level keel. I’d like to stop wondering what unusual RA complication might crop up next.

Be well, my friends,

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