Could RA cause joint stiffness in a 33-year-old woman?

Question

Hello doctor,

I am really worried about some unusual symptoms I have been experiencing lately. It has been four months now that my wrists and joints have been aching terribly, especially in the mornings. I wake up, and my hands feel stiff and painful to even move. I am 33 years old and work as a writer, but this pain is making it impossible to type or use my computer. My fingers look different; they seem to be bending slightly sideways and have this unusual swelling that does not go away. I noticed red patches around my joints, and they felt warm to the touch. My blood work last week showed some concerning numbers. My RF was 65, and my CRP level was 18, which my previous doctor said might indicate some inflammation. I am constantly tired, losing weight without trying, and feeling like my body is betraying me. Some days, the pain is so bad I can hardly get out of bed. What could this be? Is it possibly rheumatoid arthritis?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and understood your concern.

In patients with rheumatoid arthritis, Hydroxychloroquine is suggested for initial treatment in those with low disease activity.

Methotrexate is recommended for the initial treatment of patients with rheumatoid arthritis and moderate or high disease activity.
Rheumatoid arthritis treatment should be targeted according to a standardized disease activity scale.
In patients with rheumatoid arthritis who do not achieve low disease activity, Methotrexate triple therapy and the addition of Sulfasalazine and Hydroxychloroquine are as effective as adding a biologic or targeted synthetic medication, although the response will be slower.

Disease-modifying antirheumatic drugs (DMARDs) are the key to treating rheumatoid arthritis, and timely initiation can prevent joint damage. Although the multiple classes of DMARDs can make treatment decisions challenging, family physicians often prescribe these medications. DMARDs are categorized as conventional synthetic (csDMARDs), biologic (bDMARDs), and targeted synthetic (tsDMARDs). The American College of Rheumatology (ACR) published updated guidelines focused solely on the medical treatment of rheumatoid arthritis.

Conventional synthetic DMARDs:

Hydroxychloroquine.
Sulfasalazine.
Methotrexate.

Biologic DMARDs:

Adalimumab.
Infliximab.
Golimumab.
Etanercept.

With low disease activity, the doctor will suggest in this order:

Initial treatment with Hydroxychloroquine (Plaquenil), Sulfasalazine (Azulfidine), Methotrexate, and Leflunomide (Arava). Hydroxychloroquine is better tolerated and has a better risk profile than the others. Sulfasalazine is recommended over Methotrexate and Leflunomide because it causes less immunosuppression. Methotrexate is recommended over Leflunomide because of its lower cost and better dosing flexibility.

With moderate to high disease activity, Methotrexate is the best initial treatment for rheumatoid arthritis. Methotrexate has stronger evidence of disease-modifying activity than the other conventional synthetic DMARDs, Hydroxychloroquine and Sulfasalazine. Although some biologic DMARDs and targeted synthetic DMARDs have evidence of better outcomes, Methotrexate is safe and effective, with convenient dosing and low cost. Combination therapy is not recommended for initial treatment because it is unnecessary for many patients and incurs higher toxicity and cost.

I suggest you consult a multidisciplinary team, including:

Consultant rheumatologist.
Consultant radiologist.
Physiotherapist.
Psychiatrist and psychotherapy.

I hope this has helped you.

Kindly follow up if you have more doubts.

Thank you.