Happy 30th Anniversary????

Happy(???) 30^th Anniversary!

On 21 September 1984, after spending a  week in the hospital at Riley Hospital for Children in Indianapolis, IN,  we heard the words that would forever change my life. I had been in the hospital all week. But unlike the rooms where most hospital stays occur, this room was more like an efficiency room in a hotel, a private room with a small refrigerator (I think), of course a private restroom. There was less a feeling of being hospitalized and more a feeling of just staying there for tests because it was more convenient. I vaguely remember being seen by quite a few doctors and nurses as well as having lab-work, X-rays, eye tests, and other exams. We had went into the situation with a fairly good idea of the outcome. The problems I'd been having for awhile were getting less scary and more of a hassle than a major worry. i don't know if I got more used to the pain and so woke up less in enough pain to scream as had happened at first. Or if I just got used to it enough that it no longer took me by such surprise and was a shock to me. In the beginning, Mom, like most parents would have, assumed I was having nightmares. And in a way, she was right, I was having a major nightmare, but not in the way most parents consider the use of the word nightmare. I was so wracked with leg pain that i was unable to move my legs. The stiffness and pain was unexplainable really beyond the tears and saying I hurt. So, like most parents, she took me to the doctor. He was one of those old country docs who practiced in a tiny rural town in the early 1980s. I later heard that he did not have a good reputation amongst older family members, which I don't believe Mom was aware of. We left there with no clues as to what was going on. All that doctor would tell her was that I had "growing pains". But something about that just didn't sit right with Mom. I wonder if her own pain led her to see that my pain was very real and went beyond what is typically described as "growing pains". In addition to waking up at night, screaming and complaining about leg pain as well as being unable to move them, I also had a problem with my right ring finger that we later found out was called a "trigger finger" as well as a ganglion cyst on my left hand.  Over the last 30 years my hands have changed to what is now noticeable damage and misshapen fingers but not to the extent in the drawing below. I do have each of the items mentioned: boutonnière deformity in my thumbs, ulnar deviation of my hands as well as swan-necking of the first joint of some of my fingers and hypertension of the middle joints on some fingers. The  drawing is much worse than my hands are thankfully.

Needless to say, she took me to a different doctor in Danville, IN. This doctor, after examining me, declared that he was not about to treat me and that I needed to be seen by a specialist at Riley Hosp. for Children in Indianapolis. His concern was that I had either a muscular dystrophy or a form of juvenile arthritis. The next I remember was the week-long stay at Riley, which culminated in the official diagnosis: seronegative poly-articular juvenile rheumatoid arthritis, quite a mouthful for a 7 yr old! The seronegative part simply meant that there were none of the markers of JRA in my lab work, a not uncommon occurrence. In adults, at the time, at least 20%

of patients with RA were seronegative. My erythrocyte sedimentation rate, or SED rate for short (aka ESR) was elevated but it can be elevated with any kind of inflammation in the body, including infections. I had a lot of problems with upper respiratory and ear infections so having an elevated ESR was not too out of the ordinary. But I was never positive for Rheumatoid Factor (RF) at any point in my life. According to Lab Tests Online, RF is: "Rheumatoid factor (RF) is an autoantibody, an immunoglobulin M (IgM) protein that is produced by the body's immune system. Autoantibodies attack a person's own tissues, mistakenly identifying the tissue as "foreign." While the biologic role of RF is not well understood, its presence is useful as an indicator of inflammatory and autoimmune activity." I have NEVER tested positive for ESR in the past 30 years. There are more tests now that they can use to lead to diagnosing RA or distinguishing between the various types of arthritis but the last I recalled, i am either completely negative for those tests that the results are either negative or positive, or for those that have a cut off of the normal levels of what is being tested for in the blood, I am under that normal level. I have been tested for the Sjogren's antibodies, anti-CCP, CRP etc. and even now everything is either in normal ranges for that particular test or is negative. My labs still show that I am sero-negative 30 years later. Again, my SED rate is often elevated but that could be infection related as much as anything else. 

I recall the doctor thinking when we first got there that I had some form of juvenile arthritis most likely.  As the week wore on and tests were done and results were in,  I think he was more and more sure of his original thought. I remember that Mom was certain that since it was my body and my life affected by the diagnosis, that she wanted me to be told everything. I had to know what I was dealing. I don't know if my doctor, who at the time was Dr. Murray Passo, agreed with her that it was the best choice or not, but, he went along with it.  And for me, it worked. By the time I was 10, I would go to the reference section of the library and read medical books for fun. Not that I understood the greater portion of it but I understood enough. I was used as a teaching student. I was at the clinic enough that it made sense to have me as one of the patients that student doctors visited on their trips through the clinic. After awhile, because I tended to pay attention to what the doctor said, I began to be able to answer his questions if the students would or could not. It was not any great feat of intelligence I can be sure of. It was quite simply repetition. No matter a child's age, if they hear something repeated over and over, especially about themselves, they are likely to remember it. I was 10 when I asked about how RA shortened people's lives, which I think was surprising to many people. I know at one point, Dr Passo had told me the worst case scenario —that by the time I was 16, I'd not walk again, I'd be on medications for the rest of my life, I'd not work part time even let alone full-time and I'd not marry and have a family. I was determined to prove them wrong. At 10, was my hand surgery. Because of the concern of giving a child pain medications for more than a few days post-op, I did not have adequate pain control when it came time to begin PT. It was then I began considering PT to be patient torture vs physical therapy. But, I also had a hard time explaining how I hurt beyond say "I hurt," which admittedly makes it hard on a doctor to know if the child truly is experiencing pain and is used to it enough that the typical reactions to pain are not there (I can be in a lot of pain now and no one but those who know me well can tell IF I am not wanting it to show; after this long of my being filled with some amount of pain everyday for as long as I can remember, you tend to learn to mask it) OR if there is something else bothering them.  I know many of my doctors in the past had a hard time believing I was really in the pain I said I was in. Another reason I think I have such difficulty in explaining how I hurt id the fact that I truly do not remember what it is like to be pain free. I know at some point in my childhood I was pain free but it was so long ago that I do no remember it. It's as if between the time that has passed and all that my body has experienced, that those pain-free days have been pushed out of my memory.

 I do know that Dr Passo was a great doctor. Looking back, it might be wondered why I was never put on any of the disease modifying anti-rheumatic drugs available at the time. Or why I'd never been given ______. The biggest reason is simply that I was not considered to be a severe case of JRA.  This was during a time when ibuprofen and naproxen were beginning to be studied as treatments for kids with JRA. There was hope that they would work well enough that the stronger drugs with the worst side effects could be avoided. This was before the practice of "early aggressive treatment" was given the emphasis that it is given today. We know now how important it is to slow the progress of JRA in children and RA in adults as early as possible. We know now that it is in the first 10 years that the most damage occurs in those patients who are disabled by RA or JRA. As Dr Passo explained it to me, the difference between the three forms of JRA, pauci-articular, poly-articular and systemic are: those with pauci-articular JRA tend to have five joints or less affected; those with more than five joints affected have poly-articular JRA and those with salmon colored rashes, daily fevers, etc in addition to the five or more joints being affected are those with systemic JRA. As it was explained to me, polyarticular JRA is much like adult RA while systemic JRA is also known as Still's disease, which generally occurs in children but can wait until adulthood to begin, in which case it is known as "adult onset Still's disease" (AOSD). That said, poly-articular JRA, (which I will hereafter refer to simply as JRA and the other forms by their longer names) as well as adult RA both have components of the disease that are systemic. The low grade fevers common to many patients with both JRA and RA, especially during periods of active inflammation is common as is fatigue, feeling flu-like, etc. For many patients of either, slow healing cut and sores are common as is increased bruising. The bruising can be related to certain medications, primarily prednisone or other glucocorticosteroids but in some people can be part of RA/JRA. I was not on any glucocorticosteroids of ANY kind until after I was 2 and had my son, yet I bruised VERY easy as a pre-teen and teen. Even into adulthood, I bruised fairly easy. At one point in my life, I was seeing a physical therapist who, during the course of the treatment ordered by my doctor was leaving rather large bruises on me. They were not overly painful, but the PT was concerned at first as to what my husband would say when he saw them. I assured him that my hubby would know about them before seeing them so that he was not upset over them. He knows my easy bruising nature anyway and so is unlikely to become angry before giving me a chance to explain. I can understand the PT's concern  as well since I was bruised from neck to the back of my thighs, because he was doing myofascial release massage therapy, which released the knots formed by muscular waste chemicals that would build up in the muscles. It was hard work in a way to have that type of massage therapy. The waste that was broken up and released into the system caused nausea and sleepiness on the days I had therapy. So while it felt good in a

way to have those knots broken up, the sleepiness, fatigue and nausea were too much. 



After my first pediatric rheumatologist transferred to a hospital in Cincinnati, OH, I got a new

doctor that I don't recall much about. I don't recall caring much for her but then again, I am not sure if that is the case, or if she just doesn't compare one bit to Dr Passo.  I do remember him a being a great doctor. And he is the one who started to encourage me to learn all that I could about my JRA. He taught me quite a bit as well. And of all the doctors I've met over the last 30 years, and there have been quite a few, he's been one of those I have had the best memories of. I still to this day, even though it's been probably 20 years since I've seen him, would trust him implicitly. Although, in many ways, he made it hard for me to find other doctors to live up to the standards he set. I have been blessed to have a few who do.  And for those I am thankful. One of my biggest ways of knowing if a doctor will work out is how much they value a patient's knowledge. If they have a problem with patients who are well-informed about their diagnosis, then they will not work for me. I will not be treated as if I don't know my own body just to make a doctor like me better. And the doctors, as well as other health-care providers that I see currently all seem to value that in a patient. i am blessed with a great health-care team right now. I am thankful for that to be honest.  Because while I know my own body, and what is and is not normal for me, that's where my knowledge stops. Yes, I know quite a bit about rheumatic diseases but not as much as a doctor who specializes in them. But the best thing is that I do know what is and isn't normal for me and after 30yrs can usually recognize the abnormal. I say usually because as was proven in 2008, there are times a med can mask what would be normal symptoms of a problem that I was well-aware of what the symptoms felt like. Yet, when you have no symptoms of a problem, you can't exactly know it is there!  Thankfully, the medications that caused that issue are no longer ones I take or are ones I still take but at a MUCH lower dose.

Will I ever live a "normal" life again? Of course not. I have way too much joint damage as well as too much deformity etc to have what would be close to a "normal" life. But, while I know that JRA may have taken its toll on me, and it may have won some of the battles, it has NOT won the war. It can only do that if I let it knock me down mentally as well as physically.  And I will NOT let that happen if I can help it. I may not be able to do as much as I was able to do physically before the "long vacation" but it hasn't totally won yet. For that I owe quite a lot to the influence of many people over the last 30 years. But I would not have had as many tools to fight with had it  not been for Dr Passo as my diagnosing doctor. Don't get me wrong, Mom insisting i be told the truth had a big influence on me as did the influence of a number of family members.

Turning pain into wisdom

What is wisdom? Google defines wisdom as:

• The quality of having experience, knowledge, and good judgment; the quality of being wise.
• The soundness of an action or decision with regard to the application of such experience, knowledge, and good judgment.
• the trait of utilizing knowledge and experience with common sense and insight
• the quality of being prudent and sensible

I was diagnosed nearly 30 years ago at the age of 7 with juvenile rheumatoid arthritis (JRA), which causes chronic pain as well as other problems & I have had other pain causing diseases added as well. Since then, I've definitely learned a lot because of pain. I've learned that just because I have pain, it does NOT mean that my life is horrible or not worth living. Does it have it's horrible moments? Sure, there's no doubt about that. But, despite the fact that I truly do not recall a pain-free time in my life, it does not mean my life has been so bad it's not worth living. In spite of pain, I've got so much to be thankful for. Family and friends who, while they don't all know what it's like to be in my shoes, make an effort to understand are just one of the many things. Although I do have a number of family and friends (for example my mom & my bestest friend amongst others) who have their own chronic pain issues as well. I am also fortunate that my in-laws all understand my pain and I don't have the problems many women do with their in-laws.

And because of the chronic pain in his family, my husband gets it. He has stuck by me through stuff that would cause many men to run screaming in the opposite direction. We married 18 years ago today when we were just 18 and not many people ever thought we'd make it as long as we have. And yet, he stuck beside me while I was hospitalized for 11 mo unable to feed myself let alone do any self care. I was so sick that I couldn't keep even the blandest of food down, and ended up losing over half of my body weight. Meds and a lack of being able to exercise had caused my weigh to balloon. But months of nausea and vomiting, as well as a case of C-Diff,  caused me to drop from right around 200lbs (way too heavy for my 5'3" small boned frame) to somewhere between 90 and 95lbs in about 4 mo. I ended up with a feeding tube to keep nutrients in me. Once my esophagus and stomach healed, I slowly began to be able to eat again. Even now, over 3 years after having the feeding tube removed, my appetite is nothing like it was before. I was given both blood and plasma at various times. Because of various infections, in addition to the C-Diff I also had VRE and MRSA, anyone entering my room had to don a gown and gloves. In fact, I believe I was told because of my history, any future stay at that hospital means I am by default considered a patient who will require anyone entering the room to gown and glove up. I do not remember most of Jan 2009 through April 2009. Even after that, things are spotty up until the fall of 2009.  I couldn't even scratch an itch for awhile because my arms and hands were so contracted I couldn't move them. My hands were curled into a loose fist, my wrists bent so that my palms were drawn down to ward the underside of my forearm, elbows bent so that my hands rested on my chest under my collarbones. I had to learn to feed myself again, I had to learn to write again, I had to learn to stand, and then learn to walk. Because those were hard won victories, I am thankful just to be able to take care of myself, to get around with minimal assistance. I've experienced not being able to do the simplest of things for myself and that makes me value even more what I am able to do.  When the doctors all thought I was not going to make it, he did! He said there was no question about it for him because he knew I'd fight. When I was told I'd likely not walk again, he assured me we'd figure it out. I then spent the following 2 yrs  in a nursing home, where I had to learn to do all of the basic self-care tasks for myself all over again. And when I told him about having taken my first steps in Apr 2010 after only 4 mo of PT (rather than the 2-3 yrs of daily intensive PT it was predicted it would take just for me to be able to stand), he was NOT surprised. He knew I'd get back on my feet. And because of that, my son also had no doubt I'd walk and happened to be spending the day at the nursing home with me the day I did walk.

Chronic pain has taught me that I am a lot stronger than I'd have guessed. It takes mental strength to fight pain and not let it win. It takes choosing to find something good about life in spite of the pain. I also have a number of friends I wouldn't have met had it not been because of chronic pain. Because of my pain, when my best friend was having a lot of problems that were all too familiar to me, and her doctors were telling her that she was fine, I told her to keep trying to get help, because while how she felt was normal for me, it was NOT normal for her. Unfortunately, she ended up getting a diagnosis similar to mine. I am glad we've got each other to understand and all but I would have been perfectly happy to not have her know! Unfortunately, because of doctors who were not proactive, she's got a lot of joint damage and has had multiple surgeries. But we can both laugh at ourselves and at each other and we've always joked that together we pretty much make one relatively healthy person. And her surgical experiences have turned out to be helpful for me. Because I am facing a similar surgery, I have a bit more of an idea what to expect because of what she has shared with me. I know how much of an impact that type of surgery can have. I also have spoken to a number of people I've been treated by in the past and gotten various points of view that have all helped me with my decision about what I should do.

Pain has taught me that how to adapt as well. I cannot do things the way most people do them. In fact, when I had my son, the nurse sent to help me with nursing the first time kept saying I was holding my son wrong. She didn't expect me to  stand up for myself. I told her I could either hold him the way she was telling me OR I could do it MY way and know that his head was being properly supported and that I'd not drop him.  For me, adapting is second nature after all these years. I grew up having to find ways to get jobs done that made them easier on my body. I know that one time during a PT eval, when the PT asked if I had trouble lifting a gallon of milk, or carrying a basket of laundry and a handful of other household items, I began to laugh which was a puzzle to the PT. I explained that on most days, I knew better than to try to lift a gallon of milk. I generally bought half gallons or less OR when we bought a gallon, some got put into a smaller container so I didn't have to lift a full gallon. Same with heavy bottles of laundry detergent etc. I also rarely carried a basket of laundry very far. As much as was possible, I would slide the basket along the floor. Now, especially, I am unable to carry a basket and still walk since I use forearm crutches to walk. That makes sliding a basket hard too because it gets in the way of my feet or my crutches and becomes a fall hazard. And that is one thing I MUST avoid because between all of my health issues, I have also developed full-blown osteoporosis. So not only would a fall be painful, it could very well mean a nasty fracture. When I first came home from the nursing home, it took me a bit to find a way to deal with doing laundry. But one day, I took a belt, looped it through some of the holes in a basket and fastened it in a way that I could have the belt around my waist, keeping the basket's weight fairly well distributed but also keeping it from being a fall hazard. Another adaptation has been to use a bar stool in the kitchen when I am cooking. I sit at counter height to do prep work, the stool is a great height if I need to be stirring something on the stove, etc. I just gather everything I need and put it within reach and position the stool where I am in the area of counter space between the stove and sink. I can reach toward both without moving, or can easily slide the stool either way if I need to be closer to one or the other. Essentially, I've learned to work smarter not harder. I find the tools I need to make jobs easier whenever possible OR I adapt ways of doing things. Just because other people do things a specific way, it doesn't mean I have to as well.

I am also not at all uncomfortable or ashamed of using various assistive devices. I keep a grabber near by most of the time, it actually is almost always sitting in the space between my wheelchair seat and the armrest. I use jar openers. When I'm writing, I make sure to add grips to pens to make them easier to grasp. I don't care what other people think when I use a handicapped parking space, although now, it's not easy to miss the leg braces and crutches so I no longer get dirty looks for appearing just fine and not needing a handicapped space. But my husband has been assaulted in the past because he parked in a handicapped spot for me and someone had a problem with thinking I didn't need to use that spot. I have never really had a struggle over using assistive devices because I grew up using them. They're a normal part of my life. I've never had the concerns many people do over how other people see me. I grew up not having a choice...well I guess there was always the choice of not using assistive devices but that would have meant less independence for me and that is simply NOT something I would choose. If having more independence means I use a wheelchair at times or I use various devices to help me do things that I'd not be able to otherwise do, then so be it. I quite simply am not worried about what other people think. So pain has taught me to care little for doing things certain ways to keep up an expected appearance or to be like other people. My health issues require me to do things MY way and because of that, I've learned that I am the only judge of what's right and wrong for how I get things done. Do what works best for you, even if it means going against how things have always been done. So in a way, pain has taught me to follow the beat of my own drummer I guess. I don't have to be like everyone else and do things like everyone else to feel good about myself.

Pain has also taught me to have a stronger faith. I've had to rely on God to sustain me through some rough times. And I don't know that I'd have gotten through some of those times as well as I did without that reliance. Being told I was unlikely to walk again could have been a harsh blow. But, after hearing that, I wasn't destroyed emotionally. I prayed, and a sense of comfort enveloped me. I knew that whether I walked again or not, I would still be able to do what I'd been doing before going into the hospital. Just because I couldn't walk didn't mean I lost value as a person. In fact, that would open me up to be more understanding of things others were going through as well.

So all in all, if not for pain, I certainly would NOT be the person I am today. My body may not be in great working order, but, that's just life. Yes, I have pain 24/7 and in fact do not remember a pain-free life. But it could be so much worse. My needs are met; I'm blessed with relatives, chosen family and friends whom I love; I have faith that no matter what the future holds, everything happens for a reason. I have so much to be thankful for in spite of my health issues. I am blessed with a wonderful medical team who cares and does their best to help me. So yes, life with pain is not the optimal choice. But, it has taught me quite a bit of positive stuff. I believe our experiences make us into the people we are. So without my pain, I'd not be the person I am. It has made me more mature (pain as a kid has a way of making you grow up fast) and made me more compassionate toward others. I'm more tenacious than I would be had I not grown up with pain. Our experiences mold us into the person we are. How we respond to trials and challenges IS a choice whether we like to admit it or not. We can respond to pain by being angry, bitter, and unhappy but when pain changes us into that kind of a person, then it has defeated us. We also could respond by choosing to find happiness in spite of the pain, by knowing that while pain may do its best to break our bodies, it will not make us into a person we do not want to be, and we can choose to grow in spite of  (or even because of) the pain. When we respond in these kinds of ways, then no matter what pain has done to our bodies, it has not defeated us.  Just as with any other trial in life, pain can make us a better person, or it can make us a bitter person. I may have had to physically give in to pain but, because I have taken the experiences pain has given me and made the choice to not let them make me into that bitter person, then pain has not defeated me but has made me a better person. 

Does all of this make me wise? By the first definition: having experience, knowledge and good judgment, it may. I have had much experience with pain, more than I'd like. But whether it is enough is a subjective question. To one person who has no experience, they may see my experiences as being sufficient to feel they are wise yet to someone who has more experiences than I do, I would not be. The same is true for my knowledge about pain. As for good judgment, well, that is even more subjective than the other two items. Someone who is against using pain medications would see my use of them as unwise. For those who feel the use of pain medications for their intended purpose is an appropriate course of treatment, then I am only doing what is standard for pain care, which is a wise idea.

For me, the use of pain medications as well as any other medication is unwise only if the risks outweigh the benefits; if I  get decent pain control, have few side effects and what side effects I do have are tolerable or easily treatable, then the risks are worth the benefits I get. The test for me is whether my life is improved in some way given all of the variables.  Since I am treated at a wonderful pain office, my medications, side effects, interactions etc are well monitored. The dose is carefully chosen to avoid the harshest side effects while giving me the most relief possible. Finding that dose is not always easy. Even finding the appropriate medication is not easy. For many people, a medication works fine for awhile and then tolerance sets in. Some tolerance is a good thing because it leads to feeling less bothered by some of the typical side effects. For a patient who has never taken an opioid pain medication, starting one can lead to nausea. But for the person who needs that medication to control their pain, after they have taken a medication for awhile (usually approximately 2 weeks of regular use) the nausea will subside. If it doesn't, then that medication may not be the right one for them. It depends on how bad the side effects are, how much relief they get, and other things such as medication interactions, allergic reactions etc.

One thing we must remember, each person has a different view on this issue. And because each of us meet pain in very different ways, we must respect that we will all respond different. Many people would rather not have the lessons pain has taught them. And that is understandable. We should not presume to tell them that they are wrong. But, the same is true for those who value the lessons that pain has taught them. Two people could have the exact same experiences with pain and yet what is right for one. would be completely wrong for the other. Just because I view pain a certain way, does not mean that my view is how everyone should see their pain. Even my opinion on how letting pain make you bitter, angry etc means you've been defeated by pain, is quite simply that, just my opinion. Other people may not feel the same way I do. Life is not as black and white as we make it out to be.

[Edited 7/31/13 to add picture.]

Appointment at pain management

I had my bi-monthly pain appt. It went as it always does. Spent a bit letting Stacy know life is as usual, she asks the standard "How have things been?" question that I know answering with "fine" will get me the look. I don't know exactly how to describe that look either. It's almost one of those Mom looks that we use when we know there's more to the story than what we're being told. But it's not quite as maternal as the Mom look. But it's a look that says she KNOWS there's more to it than what I am telling her. I told her that there's nothing more than the normal ups and downs of life with chronic illness. That I couldn't complain....to which she replied, "Yes you can." I had to laugh at that because we've discussed in the past how complaining about the normal stuff that can't be changed does me no good. I told her about my new meds. We discussed my request to change how I take my Neurontin and Robaxin. If I took meds as they are supposed to be scheduled it'd go a bit like this:

• 6 am: Neurontin, Robaxin, Prednisone, Vesi-Care, Provigil, Plaquenil, Omeprazole, Calcium, a Multivitamin and then 2 ea. Methadone and Guaifenesin.
• 9 am: Oxycodone Technically it's PRN and I don't take it if I don't need it, but when I am up early, I am usually getting myself cleaned up and dressed around that time of day and need it then. At the nursing home, most of my nurses didn't ask or make me ask if I wanted it since they knew I always wanted it.
• 12pm: Neurontin, Robaxin, Metoprolol ER
• 2pm: 2 Methadone
• 6pm: Neurontin, Robaxin, Acyclovir, Oxycodone (PRN)
• 10pm: 2 Methadone
• 12am: Neurontin, Zanaflex, Plaquenil, Folic Acid, Arava
• 3am: Oxycodone (PRN if I am awake and need it, which is many nights)

That's a bit much. 4hrs at most between doses. And that list doesn't include any Salagen, which I can have twice a day or anything for headaches. It's a lot better than one of the nursing home med schedules they had me on. It was wacky. I didn't have but 2 hrs between a doses a couple times a day. I took meds at 6am, 8am, 9am, 12pm, 2pm, 3pm, 6pm, 8pm, 9pm, 12am & 3am. That didn't last long and thankfully Dr Wilson was great when I told him it was driving me nuts. He sent the unit mgr to work out the schedule I wanted. I don't know if that happens with too many people. But he was also the doc that if I asked for a med and a nurse backed me, I definitely got it. It didn't always take a nurse to back me either. Many times I asked and he said sure. But then again, I am not the type to just ask for meds just to get them. If it were up to me, I'd not need meds. But unfortunately, I do. So I have no choice. I've learned my lesson about leaving RA untreated. It causes more problems than it solves.

Stacy said that I could adjust the timing within limits. If I wanted to go longer than 6hrs, I could. Not shorter of course but that's not what I needed. She changed both the Neurontin and Robaxin scripts to read PRN, that way if I didn't need them a month after my fill date, the pharmacy didn't hassle me about not properly taking meds. I appreciated that. She said I didn't HAVE to take all 3 Robaxin and all 4 Neurontin if I didn't need them. But I know I need them most of the time. Now when I am in one of those major fibro flares where I am doing nothing but sleep 12-18 days then I may not need them. But I usually do because I definitely notice when I miss em. Especially the Neurontin. The neuropathy gets so bad that I just feel as if my hands are burning and tingling. And anything touching my feet, including socks, has me in that amped up pain state. So because she said I could make changes, I am gonna. What I am doing is dropping the Zanaflex and taking 3 Robaxin a day. Or if I get to where it's not letting me sleep, I have 2 other options. I can double up on Neurontin at bedtime if the neuropathy becomes an issue. The other thing I can do is drop to 2 Robaxin and take Zanaflex at bedtime. That may be what I end up doing. IDK yet. Now with the changes, my med schedule looks like this:

• 6am: Neurontin, Robaxin, Prednisone, Plaquenil, Provigil, Vesi-Care, Metoprolol ER, Prilosec, and 2 each of Methadone and Guaifenesin
• 10am: Oxycodone PRN
• 2pm:Acyclovir, Neurontin, Robaxin, and 2 Methadone
• 6pm: Oxycodone PRN I only take this if I really need it, although many times, I don't need it. 
• 10pm: Neurontin*, Robaxin, Folic Acid, Arava, Plaquenil, and 2 Methadone. *I am allowed a second Neurontin if I need it. 

She was glad I had success with Candyce. We were discussing the addition of acyclovir to my med list because of shingles. That got us discussing the shingles vaccine and whether people who have had shingles can get the vaccine. I thought I'd read that they could but didn't know for sure. (I looked again when I got home.  And that is what I'd read. So I left her a FB msg about that.) Then as she walked me out to the desk I told her again how glad I was to be back in her care. She hugged me and thanked me for saying that. Then I just had to wait on Gar to finish up with his 2 runs. He had 2 ppl at appts and needed to run them home, then he switched vehicles and got his paperwork for today so he could just come home when he picked me up. I kinda crashed for a bit, then looked up the info I wanted to find for Stacy and sent it to her and called Mom and that was it. I was wiped out.

Now I have NOTHING appt wise until 9/25 when I see Stacy at 2 and then labs at 3:30 and I see Candyce at 3:45! That will be interesting!

Follow-Up with New Nurse Practitioner

Follow-Up with New Nurse Practitioner

Another good visit all in all. The nurse Joyce is great. Shocked her by telling her a bit of my past. Especially about the not walking part and docs at the hospital saying how it was unlikely I'd do so or even live at home. Her jaw dropped and she said, "So where are you living now.?" When I told her that I've been home since Nov. 2011, she was happy to hear that. I've somehow managed to drop 2lbs. It took no time for Candyce to come in. I like her. She's not the type to sugar coat things. She did acknowledge that she had to tell me things she knew I was likely aware of just to make sure I knew. It was nice to have it acknowledged that I am a pretty-well informed patient. There's a lot of good news/bad news. Good news on x-rays: my cartilage in my knees is not bad. Which leads to the bad news (that was no shock to me as I had a guess what showed. The pain and swelling is RA, not OA. There's erosions, which to be honest is not shocking as out of the 28 years I've had JRA/RA, I wasn't on DMARDs until 2002. I was on Plaquenil/MTX in varying doses for a little over a year in 2002-03, then off meds until 2006. And then I was on MTX, Arava, Imuran, Enbrel, Humira, and Remicade in various combos until Aug 2008 when I went off Remicade because I lost insurance. I did have Arava, Neurontin and some other meds until Dec 2008 when I got sick on Dec 12 with what I had thought was the stomach flu at first, but after 3 days realized was likely not the flu and was possibly another UTI. Then no DMARD until I restarted Arava in 2010. But that's another story for another day...or week. So the fact there are erosions in my knees, hands, and wrists wasn't too shocking. She doesn't think Arava is enough which is why she added Plaquenil, it's as much for the Sjogren's as it is the RA as she did say Arava doesn't really help Sjogren's. She is planning adding Rituxan but NOT until I can deal with the dental issues that the Sjogren's has caused, because she said to do so is basically sepsis waiting to happen! Even if she felt the risks outweighed the benefits, which I don't see any sane, responsible doc doing in my case, I'm not too willing to risk it, given what all happened the last time I had sepsis. Missing 3 full months and large chunks of another 6-9mo of my life  is NOT something I want to risk if I can help it.

Again she addressed issues before I could ask my questions! On my list was med refills and we started with that list. I also wanted to ask about her mention of a shingles preventative at my first visit. I wondered if, since the treatment for shingles is the same med as for other forms of herpes (antivirals like acyclovir, valacyclovir, and famciclovir) and the maintenance dose to help lessen the chance of  outbreaks of the other forms is taking the med that treats it in a lower dose daily. I don't recall what I was on dose wise for treatment but she verified that I was right in thinking that the treatment and preventative meds are the same ones and she put me on acyclovir 200 mg, once a day. (I later recalled that the 3 times I do remember being treated for shingles, I took meds something like 5 times a day, and the dose of acyclovir for treating shingles is 800mg 5x/day.) She also decided that since my BP was up (for me not as much as it has been in the past) around 140/110 we're treating it. She chose a beta-blocker, metoprolol er 50mg/day. I was on metoprolol in the past. So that's good because I don't recall any side effects. Except good ones, such as less headaches, because it lowers my BP. When my BP is high, I tend to get really bad headaches.

My DEXA scan showed severe (although she didn't give me the numbers) osteoporosis (OPO). Again, just part of corticosteroids, although I forgot to mention that I'd had the OPO dx long before ever taking any form of corticosteroids. And of course she is putting me on something for that. I don't have details yet; she said I'll probably get a call within a week or two. She is referring me to a place called Palmetto Infusion (where I went for my Remicade) for Reclast. She likes that it's once a year and I'm done. Little chance of me being non-compliant! I am good with that. But she said it will do little good to start Reclast unless she also addresses the issue with my Vit D being very low (again no mention of level). I can ask for copies of labs and the results of the DEXA and x-ray reports. I just had so much on my mind  that getting that was the last thing on my mind! So she prescribed Vit. D3 50,000 IU once a week for 12 weeks. I did forget to ask if she wanted me to continue calcium w/vit D or switch to straight calcium and what dose she prefers me on so I called and left a msg with Joyce about that.

Her plan for AFTER I deal with my teeth is to have me get Rituxan infusions. And then after awhile on that and hopefully seeing the improvements many people see, she will send me to a DO who has a good success rate with helping contractures as well as starting pool therapy. I need to let her know of the issue I have with even heated pools causing me to have serious muscle problems for days after being in the pool and doing nothing (since I can't swim) but stand in shoulder deep water. But, who knows, I may not have that reaction any longer since I am on meds and when I had that reaction I wasn't. That was right around my fibro dx. She did say IF I wanted PT we could discuss it then. So basically neither she nor Dr K wants me to have PT right now! Which is good and bad. So I get to look for options for dental ins. and possibly have to wait out the pre-existing issues clauses. But I'm not dealing with ANYTHING else health related today except a stop at the pharmacy. Tomorrow is soon enough. But today I have other plans!

I have the remainder of the eye testing Thurs. and then NOTHING ELSE until the end of July! YAY!!!! I don't go back to Candyce until 9/25. She gave me 3 mo of everything with 1 refill on everything except the Arava and Vit D. So, can't complain there! My biggest concern was not knowing how she was on pred use and then what happens when it started causing cataracts. But she seemed to feel as I do about it. She acknowledged that she was sure I knew a few things about pred but that it is a band-aid approach that controls the symptoms not the disease. I am aware of that but given I cannot take NSAIDs daily, pred is my best option (although somewhere I read that it has DMARD-like properties in addition to the anti-inflammatory ones but that's not many who feel that's true). She also said that cataracts are common with pred use, especially in higher doses or with long-term use, both of which fit me. Although that high dose no longer applies and I am trying hard to keep it that way! And so aside from forgetting I needed that script, which she asked me to double check and make sure she got em all and when I looked, I missed that she skipped 2 meds I needed. I caught one before either of us left the office, just as she was walking out the door, but the pred I didn't catch until late last night when I was telling Mom about my new meds. But I have enough to last until sometime in July so I can call and ask them to either call it in or have Gar pick it up sometime between now and when I run out. 

My meds are now:

Acyclovir (shingles prevention), Arava (RA), Folic Acid (side effects of Arava), Guaifenesin (chronic sinus congestion), Methadone (pain), Metoprolol (hypertension), Neurontin (neuropathy), Oxycodone (breakthrough pain), Plaquenil (RA and Sjogren's), Prednisone (RA), Prilosec (GERD),  Provigil (sleepiness), Reclast (osteoporosis), Robaxin (muscle spasms), Salagen (dry mouth), Vesi-Care (bladder problems), Vit. D (Vit D Deficiency).

Hydroxychloroquine Retinopathy, Glucocorticosteroid Induced Cataracts and Rheumatoid Arthritis

Hydroxychloroquine Retinopathy, Glucocorticosteroid Induced Cataracts and Rheumatoid Arthritis

Your eye is a complex and compact structure measuring about 1 inch (2.5 centimeters) in diameter. It receives millions of pieces of information about the outside world, which are quickly processed by your brain.

Today I had an eye appt  because  I needed to have a baseline exam done since I just recently started taking Plaquenil again. Turns out it was a good thing but not because of the Plaquenil. The problem with  Plaquenil is that it can cause retinopathy.  So when a patient starts taking it, they need to have an exam within 12 mo of beginning the med. Normally it needs to be done by an ophthalmologist. The doctor I went to is technically an optometrist but they have the proper training and equipment to do the needed testing. I noticed on their website that they do treat diabetic retinopathy, so obviously they know what they're doing. They do have an ophthalmologist that does come in weekly. I had called to set up my appt, told them the testing I needed and expected them to say I had to wait for the day the ophthalmologist was in. But it was explained to me that their optometrists were trained to do everything the ophthalmologist could do except eye surgery. In that case, I don't care either way who does the testing as long as they know what they're doing and are familiar with what I need to have checked and done. We set my appt for 3:45 and so I arranged for transport. I knew I was having my eyes dilated. That's part of the testing. They called me that morning to say the doctor I was scheduled to see had to go out of town and did I want to come in around 9:30am? I couldn't change my transportation so she asked if I minded seeing a different doctor. I told her I didn't mind as long as they knew what I needed. So I got there and got checked in. I don't think I waited even 10 min before they called me back.

The tech did a test of my peripheral vision and said I saw ALL of them!! Then we dilated my eyes. Wasn't as bad as I thought it would be from my memories as a kid. The doctor was a younger guy, mid to late 20s. Very nice. Asked about my nickname, but then when I said that I DO go by Wayney most places, his reply was "I am going to call you Mrs Porter" which is up to him but makes me feel old. I ought to tell him Mrs. Porter is my hubby's grandma! He did a few of the needed tests today as it was kinda late in the day, I go back next Thurs to finish up one or two exams. I have almost 20/20 vision but need reading glasses, which I already have in the strength he said I needed. There was only one small hitch in the appt. A teensy weeensy bit of news that's neither surprising nor good. I am farsighted and because of this barely there problem, he said it's as if my eyes have to work doubly hard to see as well as they do. The problem? I have the beginnings of a cataract in my right eye. Oh lovely. As I said, I'm not too surprised. Not much surprises me medically anymore I don't think. So it's something to just keep an eye on, no pun intended (my words not his). So aside from the knowledge that I'll more than likely be having cataract surgery in the future, it was a good check-up. I was honest with him about knowing what caused me to start getting a cataract at age 35, 20mg/day of pred for an extended period of time. Aside from burst and tapers, I hope I never get on that high of a dose again. But it was justifiable at the time. I don't blame Dr T at all as I knew full well the risks and just couldn't face how much pain I was in and how much stiffness I had without it and how the dose needed to be where it was to keep me comfortable.

Normal vision (left) becomes blurred as a cataract forms (right)
Image from Mayo Clinic

A cataract occurs when the lens of your eye becomes cloudy. Eventually, a cataract can advance to the degree of the one shown in this person's right eye
Image from Mayo Clinic

I did ask what his opinion on testing for Plaquenil induced retinopathy was and he said up to the 5 yr mark and especially if taking doses of more than 400mg/day, then the risk is higher than for those taking less than 400mg/day and on it less than 5yrs. I believe he said before the 5yr mark, the incidence of problems is about 1%. I think it is a tolerable risk as low as it is. And he did make sure to warn me about the long lasting affects of Plaqenil.

Plaquenil Toxicity

Normal Macula

 Macular images from

Alberta Retina Consultants

Some resources about Plaquenil (hydroxychloroquine) and retinopathy:

  

Screening for Hydroxychloroquine Retinopathy 08/2011  This is the American College of Rheumatology Position Statement 

Hydroxychloroquine (Plaquenil) is a commonly used medication in the management of various rheumatic diseases. Standard doses used by rheumatologists are 200mg to 400mg per day.  Although serious toxicity with hydroxychloroquine is very unusual, the most important is retinal toxicity. More than forty years of experience in monitoring retinal toxicity has documented that it is extremely rare. The American Academy of Ophthalmology (AAO) has reviewed the cumulative experience with hydroxychloroquine and has published updated recommendations for retinal toxicity monitoring summarized below. Ophthalmology 2011;118:415-422. The purpose of monitoring is to recognize early toxicity, not the prevention of toxicity. Once abnormalities are observed, toxicity has occurred and it may not be reversible. While there is a strong suggestion from the literature that toxicity is cumulative with adose greater than1000 grams and duration of treatment over 7 years, the majority of cases involved doses of more than  6.5 mg/kg/day and more than 5 years of use. Of more than one million patients using  hydroxychloroquine, fewer than 20 cases have been documented with doses less than 6.5  mg/kg/day, and all occurred after 5 years of use. The AAO is concerned that retinal toxicity, although rare, may be more common than previously recognized, based on a study by F. Wolfe et al which found risk exceeded 1% after 5 years.

Patients beginning hydroxychloroquine therapy should be informed of the possibility, although
extremely rare, of retinal toxicity and that periodic monitoring can limit the toxicity by early recognition. The AAO recommends that the following factors be taken into consideration when  assessing increased risk for hydroxychloroquine toxicity: cumulative dose of 1000 g, treatment  for more than 7 years, obesity, significantliver or kidney disease or advanced age, and pre-existing retinal, macular disease or cataracts.

All individuals starting these drugs should have a complete baseline ophthalmologic examination  within the first year of treatment including examination of the retina through a dilated pupil and  testing of central visual field sensitivity by an automated threshold central visual field testing  (Humphrey 10-2 testing). Examination by Amsler grid is no longer recommended as it is deemed  too dependent on patient interpretation. If available, examination by an objective test such as multifocalelectroretinography (mfERG), spectral domain optical coherence tomography (SD-OCT), or fundus autofluorescence testing (FAF) is also recommended. If the patient is considered low risk and these examination results are normal, the AAO recommendation is that  no further special ophthalmologic testing for hydroxychloroquine toxicity is needed for the next 5 years. Some ophthalmologists may elect to screen more often based on the patient’s age and  other risk factors. For patients who are considered high risk, annual eye examination is  recommended without the initial 5 year delay. If any abnormality is detected by Humphrey 10-2  testing or retinal examination, follow up with the previously mentioned objective testing is  imperative. The sensitivity and specificity of each of these objective tests for  hydroxychloroquine toxicity is still being determined. 

If toxicity is suspected or documented, ideally the drug should be stopped. However, there are  situations when this is not an easy decision, e.g., if the impression of toxicity is early or tenuous,  or if the treatment has been very effective. Alternatives to hydroxychloroquine are potentially more toxic. The rheumatologist, ophthalmologist and patient can make a cooperative decision to  stop the drug or cautiously continue it with close monitoring, with the knowledge that some vision could be lost.

Appropriate standards for children and adolescents have not been sufficiently addressed in the  available literature. Retinal abnormalities or new interference with vision (including color vision)  can be an indication of toxicity and should be discussed with the consulting ophthalmologist on  an urgent basis. Useof hydroxychloroquine in children younger than 7 years of age may be
limited by difficulty in obtaining satisfactory evaluation of color vision in this age group. For this  reason, the pediatric age group should receive an annual examination, as a minimum standard of care, until definitive studies in children suggest increasing this monitoring interval.

Approved by the Board of Directors: 03/03, 05/06, 8/10 8/11 

Information on Plaquenil (hydroxychloroquine) toxicity:
Chloroquine/Hydroxychloroquine Toxicity - Very in depth article by Emedicine via Medscape

Hydroxychloroquine Retinopathy Still Alive and Well

Revised recommendations on screening for chloroquine and hydroxychloroquine retinopathy.

The image on the upper left shows light properly focused by a clear lens. The image on the lower right shows scattered and nonfocused light caused by a cataract.
Image from Mayo Clinic

 

Information on cataracts:

Cataracts - from MedicineNet

Cataracts: 3 Common Types, Plus Symptoms, Signs and Treatments

Cataracts, Facts About [NEI Health Information]

Cataracts - MayoClinic.com

Cataracts | Causes, Symptoms, Diagnosis, Treatment, and Prevention

 

  Cataract surgery

 

I had an appt today with a new NP. She specializes in rheumatology and that is her bigger concern right now than anything else. I got there a little early and had my paperwork all filled out. Thanks to Foxit PDF Editor I was able to type all my info after I downloaded the forms from the office's website. Much easier on my hands! When the nurse called me back, she kept telling me I needn't rush. But I wasn't rushing so much as I am conscious of the fact that I need to try to pick up my speed when I am on a flat surface with few obstacles. I tend to try to pick up the speed just because on that kind of surface, I CAN walk a bit faster. We weighed me and I let her know that my braces are 6lbs since I cannot take them off and stand up to be weighed. She took me into the exam room and asked if I could get up on the table. Yup. She stood close enough to grab me if I had a problem. She commented on the forms. Asked me who typed em up and when I said I did, she thanked me because so often, it's hard to read patient's writing. I said that is part of why I did it on the computer as well as how much writing hurts after awhile. She took my BP and it was a tad high. 130ish over 80something. She attributed it to me rushing. It was possibly that or the pain from this flare. She was REALLY nice. She did decide not to have me change to the gown for my exam, although it wouldn't have been a problem.

When the NP came in, she was really nice. Asked lots of questions, and in asking her questions she basically addressed all but one item on my list. The only thing we didn't go over was me wanting some Voltaren Gel. But I decided to wait because I know there had been shortages of it recently so I decided to see if that had changed before asking. Why waste her time and mine if there was a shortage still? She is concerned about lupus. She didn't say if her concern was RA plus lupus OR that I've been misdiagnosed all these years. I told her I'd been tested but always negative. Which means NOTHING really. Last I read, 5% of people with lupus were sero-negative. And I've read anywhere from 20-30% of people with RA are. I've only seen the 25% and 30% figures a few times; 20% is the common number of sero-negative people. She wants me on Plaquenil. And of course that requires the baseline eye exam for retinopathy. Of course she also did labs and a U/A. I hate trying to fill the cup given my hand issues. It's never easy. I got my blood drawn. The ladies in the lab at the internist's office were nice. I went in and they were trying to tie up things. And one of the ladies said she was ready to scream as she misplaced something she JUST had. The other one said not to scream since a pt was in the room. I told her go ahead. I've been around healthcare long enough to know sometimes you just need to scream. When the woman came over and asked where it's best to get my labs, I said it was her choice and offered both arms or the back of both hands. I told her some people have a lot of problems with my arms and the veins rolling a lot. And I have a lot of scar tissue from the 28 years of labs. So she decided to use the back of my right hand. The one who wanted to scream said they'd get it, they could get it from pretty much anywhere: arms, hands, feet, head. I laughed and said that I've had labs and IVs in all those but my head. I commented that I wouldn't watch her put the needle in but I wasn't gonna pass out or anything. I just found looking away lowers the pain. I found that out years ago. And then I mentioned that study I recently posted on the subject. She said they've told people that for years.

The NP will NOT start me on a biologic until my mouth is fixed, because it's a breeding ground for the germs that cause sepsis. I wasn't surprised. My teeth needed work before I went into the hospital and they worsened there. I am not wanting to risk sepsis at all. Been there, done that, got the scars to show. I wonder if I really need a biologic as it is. I am hesitant to use one because of my past with what happened because of Remicade. I wonder if using just an older DMARD, in my case Arava and now combining it with Plaquenil (I believe she said that was more for the Sjogren's but I'm not 100% sure) might be enough. I've had a number of flares in the last year, but a lot of it starts as a fibro flare that causes my muscles to be stiff and sore, plus the fatigue. That means I don't move as much which means my joints stiffen up more. So often that's what happens. It's rare to have a flare start with RA. I mentioned to her that it'd take a lot of Valium for me to be able to face the dentist and she said they'd put me out with all that needs done. Yay. I can handle that as long as I don't have to listen to the sounds of what they're doing. I hate my mouth being messed with. I also hate mouth pain. I can tolerate a good bit of pain without little complaint. My pain doc is amazed at my tolerance. But when it's mouth pain, I am not so good with that.

I also have to get x-rays and a DEXA scan. She's asked for hands and knees but not my feet since that would mean standing and that's kinda impossible for me! I got that appt scheduled for Wed. The eye doc is Thurs. and I go back to the NP next Mon. I absolutely do NOT think Gar needs to be taking off work that much in that short a time to drive me to the doc's. So I decided to use medical transport. I can certainly request the company he works for although it's not a guarantee I'll get it. I did tell them I HAD to have either a mini-van or a car as I cannot step into larger vans. Calling to schedule transportation was a hassle and a half. I see why clients get annoyed. Unfortunately many take it out on the drivers who have NOTHING to do with the company who schedules the transportation. The company that Medicaid has the contract with to do scheduling is one I don't think I've EVER heard anything good about. The people who had to deal with them at the nursing home ALL said it was a hassle. The people at the cab companies mentioned the hassle. Gar has had ONE complaint since he's been a medical driver and it was NOT a client complaint, it was the company that schedules transport and they complained over the mistake that occurred that left him at a dialysis center OVERNIGHT. The office manager/scheduler at the company he works for defended him, they pulled the GPS to prove he stayed within a few miles of the office. He did leave shortly after dropping the client off to grab a bite to eat, go to the restroom etc. And then later that evening he left for food and the restroom. So I knew before making the call that it wasn't going to be fun. And it wasn't. I had to repeat info 3-4 times. I can handle giving my info and then them reading it back to verify it, and she did that AFTER me having to repeat things multiple times. It was VERY annoying! Then since I had 2 appts. I figured she'd take my info for one, then take info for the second. OH NO! "I'm going to have to ask you to hang up and call again to schedule your other appt because of the high call volume we are experiencing today." They'd not have so much trouble if they didn't hire idiots who can't listen! I needless to say waited a bit to call back and I was SO hoping I got a different person. No such luck. I know they monitor calls or tape them and I know they have scripts at times, but I look at it this way, if the caller has addressed something, they are wasting the caller's time to repeat it multiple times! Even before requested the company Gar works for I said "I know you cannot guarantee this and it could be ANY company that this is assigned to but I'd like to request DiamondMed." She said "I'll put that in but I can't guarantee it." I was almost at the end of my rope with her because of having to repeat things so often and then her telling me what I had already said I knew. I finally said that I had already said I understood that and wasn't an idiot who needed told what I already acknowledged. Then I said I needed to add a stop at the pharmacy when I went home. She said she needed to know when they needed to pick me up at the doc's office. Now, how am I supposed to know when I will be done with a dr's appt? If I were going for an infusion or something that'd be different. Or even if it were a monthly appt like with Stacy where I could judge how long it would take. I have no clue. I told the woman I had no idea. My last appt was at 3:20pm and left there around 5ish. So I can't guess. I didn't wanna tell them a later time than I'd be and be stuck there waiting, especially after the office closes. But if I told them too early of a time, they'd come, wait a bit and then leave and who knows when I could get a pick up then. After I call they have an hour to get me. But, that doesn't mean they will wait very long on me if I am not done when I said I am done. And she told me that if I need to go to the pharmacy, I HAD to schedule a pick up time, they cannot do a will call. So I said forget the pharmacy. I'll figure that one out on my own then. Actually I will just hand Gar the script and he'll drop it off as he drives by of a morning and pick it up that evening when he drives back by. Or if he is in the area and has wait time then he'll pick it up and possibly run it to me. I was just trying to save him that trouble. I have GOT to find some time to go try my driving so I know if I can get my license or not.

I did get an idea of a good eye doc. It's an office that has both optometrists and an ophthalmologist. I checked out their site before calling them. One thing I noticed is they take care of diabetic retinopathy, which made me think they could do what I needed as the problem with Plaquenil is that it causes retinopathy. So I took the chance since they would work for me and called. When I explained what I needed, they said yes they could help me. And I didn't have to wait for the one day the ophthalmologist was there as their optometrists have the training to do everything the ophthalmologist does EXCEPT surgery. Ok, works for me. That seems to be a rare thing as most optometrists don't have the equipment or training to do the baseline exam. I did verify that I was ok starting the Plaquenil before my appt as it takes so long to really get in my system and it takes a bit of time to do the damage. Some sites I read say even up to a year after starting for doing a baseline. Just on my own, I'd say it'd not be good to wait a year. But it's not like it's instant either. I was surprised when I read the new ACR guidelines I posted the other day, they now say IF the first check is good and you don't have any symptoms, you can wait 5 yrs to do a follow-up exam. I was really surprised as it's always been every 6 mo if you have a more conservative doc or yearly if you have a less conservative doc. I'll find out how conservative mine is later on I guess.

Lab-wise, she ordered ANA with Reflex, C3 and C4, CBC with Diff, CCP Igg Abs, CMP, T4, TSH, and Vit. D (25-hydroxy). I know I looked some of these up but not all of them and it has been awhile. 

That was my appt. She was really nice. I liked her. When I checked my notes to see if we'd covered all that I wanted to, she had covered it all without me mentioning any of what was on there. I told her that and she said well she didn't have to ask most of her usual questions either because I provided such good notes with my pt info packet. I'd listed a number of things going back as far as I could recall. I included pics of my leg wound with the cellulitis. How it looked when we came home from MUSC and then what it looked like when it burst open and how it looked after they cleaned it up and then how it looked about a yr after it all happened. I wrote a short history of the hospitalization. A short list of each dx, when it happened and who dx'd me. I provided names, addresses and phone #s of prior docs. I even took the release and duplicated it for Dr T's office, Dr K's office, the hospital and the nursing home. I also signed the release to have them release info to Gar and my Mom if need be. I did forget to ask them to send the report to Stacy but I will add that to my list of things for next Mon. I'll also ask the eye doc his opinion on how often I should be re-tested.

Looks like things are falling into place now. I wish it hadn't taken so long. I honestly wish that the first doc I had at the nursing home hadn't retired. I LOVED Dr Wilson. He was so laid back. If I needed ANYTHING, all I had to do was go to one of the nurses I felt most comfortable with (and whose judgement I trusted) and tell them I'd like a med or needed a shot and if they thought it was a good idea, they told me and then made it happen; if they felt it was a bad idea, they told me and we either found an alternative or we tried what I wanted). When I complained about how my meds were scheduled, he told me to speak to the unit mgr and we could sit down and figure out a schedule that was better for me and he'd write the needed changes. His son is an internist as well but their office is in Conway and I didn't wanna have to make the trip up that often, although I don't mind going every 2 weeks for the ministry group. So I guess if I had to, I would have checked to see if he was taking patients. Although no one I know knew much about him. One thing would have been convenient, Dr L, who did my braces was right next door. I loved Dr L and his nurse Danni. Actually the whole staff, Miss Pat and Nancy. are both very nice. I made a comment on FB one day about the joint on my braces being stiff and squeaky and how I wished it was as easy to get MY joints to loosen up and stop popping as it is to get the brace joints to loosen and quit squeaking. She said I should make my appt to have Dr L look at em. I don't think it's enough for that as it happened while I was in the nursing home and Jim called Dr L and that was the fix. They're not squeaking as bad as they had been while it was winter and when it's rainy. Weird, the brace joints react kinda like my own do with the weather!

EULAR2012 Abstracts

Abstracts 2012

Accepted Abstracts are published with the intention to offer delegates an opportunity to prepare for planning to participate in a particular session or to visit the Poster Sessions during EULAR 2012.


Full content is available now and is not subject to embargo any longer.

Use this link to access the FULL ABSTRACT TEXT Publication Website >>

Or use the link below. it's same as the above text link but I prefer seeing the actual link if I am being taken away from the original site.


https://b-com.mci-gr.../EULAR2012.aspx


I was going to post the titles and links to the abstracts but there are over 3400 of them, so I will not be doing that! But I'll post a few that jump out at me. I am not even taking time to go through all 69 pages of abstracts. I am also not reading these since I do not wanna have my eyes glaze over today. I have a bit of a headache and I know plowing through the scientific abstracts will make it worse.


CD8+ T CELLS IN RHEUMATOID ARTHRITIS - DIFFERENCES BETWEEN REMISSION AND ACTIVE DISEASE

CYTOKINE PROFILE IN CD4+ FOXP3+ LYMPHOCYTES OF RA PATIENTS TREATED WITH TOCILIZUMAB AND CLINICAL CORRELATION (DAS28-CPR, RHEUMATOID FACTOR

ANALYSIS OF RECOMBINANT MONOCLONAL ANTIBODIES FROM SINGLE B CELLS REVEALS EARLY DEFECTS OF B CELL TOLERANCE CHECKPOINTS IN PATIENTS WITH SJÖGREN'S SYNDROME

ASSOCIATIONS OF PLASMABLASTS WITH DISEASE ACTIVITY AND THERAPIES FOR RHEUMATOID ARTHRITIS

IL17 AND IFN GAMMA ARE IMPORTANT IN THE SEVERITY OF KIDNEY DISEASE IN SLE

B CELL DISTURBANCES DIFFER BETWEEN TAKAYASU ARTERITIS AND GIANT CELL VASCULITIS

CD4+CD25-GITR+ REGULATORY T CELLS ARE EXPANDED IN THE BLOOD, DISPLAY SUPPRESSIVE FUNCTION AND ARE INVERSELY CORRELATED WITH DISEASE ACTIVITY IN PATIENTS WITH PRIMARY SJÖGREN'S SYNDROME

ANALYSIS OF GENETIC POLYMORPHISMS IN FOLATE PATHWAY AFFECTING THE EFFICACY OF METHOTREXATE IN JAPANESE PATIENTS WITH RHEUMATOID ARTHRITIS

ASSOCIATIONS BETWEEN ENOS POLYMORPHISMS AND SUSCEPTIBILITY TO SYSTEMIC LUPUS ERYTHEMATOSUS: A META-A

IMPACT OF ADDITIONAL GENETIC MARKERS OF RHEUMATOID ARTHRITIS ON PATTERN OF FUNCTIONAL STRESS RESPONSES

GENE-GENE INTERACTION AND EARLY RHEUMATOID ARTHRITIS: EFFECTS ON THE RESPONSE TO THERAPY

A PLS MULTIVARIATE MODEL TO PREDICT RA RADIOLOGICAL SEVERITY BY SELECTING KEY PREDICTORS FROM A LARGE PANEL OF SNPS AND ENVIRONMENTAL FACTORS

TUBULOINTERSTITIAL INJURY IN LUPUS NEPHRITIS AND GENE EXPRESION OF KIM-1.

ASSOCIATION STUDY OF GENETIC RISK VARIANTS FOR PSORIASIS IN A LARGE COHORT OF PSORIATIC ARTHRITIS, PSORIASIS AND CONTROLS OF THE SPANISH POPULATION AND ASSOCIATION WITH RELEVANT CLINICAL SUBPHENOTYPES.

HLA-G MAY PREDICT THE DISEASE COURSE IN PATIENTS WITH EARLY ARTHRITIS

THE UNCOUPLING TJ CLUSTER IS A PROTECTIVE FACTOR AGAINST OSTEOARTHRITIS IN SPAIN AND UK

MICRORNA-223 IN SYNOVIAL TISSUE OF RHEUMATOID ARTHRITIS AND OSTEOARTHRITIS PATIENTS.

CNSTREAM2: A POWERFUL TOOL FOR THE STUDY OF THE GENETIC BASIS OF RHEUMATIC DISEASES.

ASSOCIATION OF FCGR2A WITH RESPONSE TO INFLIXIMAB IN RHEUMATOID ARTHRITIS PATIENTS

GENETIC POLYMORPHISM IN GDF-5 GENE AS RISK FACTOR FOR DEVELOPMENT AND PROGRESSION OF OSTEOARTHRITIS

REGULATORY T CELLS IN RHEUMATOID ARTHRITIS, SYSTEMIC LUPUS ERYTHEMATOSUS AND BEHCET'S DISEASE

NO EVIDENCE FOR PREMATURE IMMUNOSENESCENCE IN NEWLY DIAGNOSED, NON TREATED, SHARED EPITOPE-POSITIVE PATIENTS WITH RHEUMATOID ARTHRITIS

ADALIMUMAB ELICITS A RESTRICTED ANTI-IDIOTYPIC ANTIBODY RESPONSE IN AUTOIMMUNE PATIENTS RESULTING IN FUNCTIONAL NEUTRALIZATION.

THE ABNORMALITY AND CLINICAL SIGNIFICANCE OF T HELPER 9 CELLS IN PATIENTS WITH RHEUMATOID ARTHRITIS

GAMMADELTA T CELLS AND THEIR INTRACELLULAR CYTOKINE PROFILE IN PERIPHERAL BLOOD OF PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS

ENHANCED PHAGOCYTOSIS AND SUPEROXIDE ANION PRODUCTION BY NEUTROPHILS IN EARLY RHEUMATOID ARTHRITIS PATIENTS RELATED TO POSITIVITY TO ANTI-CYCLIC CITRULLINATED PEPTIDES AND RHEUMATOID FACTOR

EXPRESSION OF NLRP3-INFLAMMASOME-RELATED TRANSCRIPTS IN PERIPHERAL BLOOD OF RHEUMATOID ARTHRITIS PATIENTS TREATED WITH INFLIXIMAB


DISTRIBUTION OF BLOOD DENDRITIC CELL SUBSETS IN PATIENTS WITH RHEUMATOID ARTHRITIS, SPONDYLOARTHRITIS AND PSORIATIC ARTHRITIS TREATED WITH ETANERCEPT.ANALYSIS OF CIRCULATING IMMUNE COMPLEXES CONTAINING PAIN-ASSOCIATED MOLECULES IN KNEE OSTEOARTHRITIS

MATERNAL COLLAGEN-INDUCED ARTHRITIS AND CO-ADMINISTRATION OF ETANERCEPT CHANGE TNF PROTEIN LEVEL IN PLACENTA AND EPIPHYSEAL CARTILAGE IN FETUSES

THE EFFECT OF PHYSICAL EXERCISE IN THE CYTOKINES LEVELS IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS

THE ENDOGENOUS ANGIOSTATIC MEDIATORS ENDOSTATIN AND THROMBOSPONDIN-1 ARE INCREASED IN PSORIATIC ARTHRITIS

SOLUBLE UROKINASE PLASMINOGEN ACTIVATOR RECEPTOR (SUPAR) FOR MONITORING INFLAMMATORY ACTIVITY IN DIFFERENT RHEUMATIC DISEASES

HIGHER LEVELS OF METASTASIS-INDUCING S100A4 PROTEIN LEVELS ARE ASSOCIATED WITH LESS FAVOURABLE TREATMENT RESPONSE TO DISEASE MODIFYING ANTIRHEUMATIC DRUGS IN FEMALE PATIENTS WITH RECENT-ONSET RHEUMATOID ARTHRITIS

SERUM INTERLEUKIN-34 LEVELS INCREASE IN RHEUMATOID ARTHRITIS BUT ARE NOT ASSOCIATED WITH JOINT DAMAGE

EFFECT OF CHONDROITIN SULFATE ON THE FACTORS INVOLVED IN SYNOVIAL INFLAMMATION

HIGHER LEVELS OF TH17/23, TH2 AND PROINFLAMMATORY CYTOKINES LEVELS IN SYNOVIAL FLUID OF RHEUMATOID ARTHRITIS COMPARED WITH PSORIATIC ARTHRITIS

THE ASSOCIATION OF INTERLEUKIN 23 CONCENTRATION WITH CLINICAL COURSE OF SYSTEMIC LUPUS ERYTHEMATOSUS

ANGIOGENIC AND ANGIOSTATIC MEDIATORS IN SPONDYLOARTHRITIS

IL-6 BLOCKADE ENHANCES THE THERAPEUTIC EFFECT OF STEROIDS

A UNIQUE SUBSET OF RHEUMATOID ARTHRITIS DEFINED BY A DISTINCT SERUM CYTOKINE PROFILE [I've LONG thought that there are subsets of RA but I've not seen much on docs discussing the subsets. Just as there are subsets to juvenile arthritis, I fully think there are similar ones with RA. Which would explain why some people are not bothered very much by the symptoms many of us have.]


IL-18: A SEROLOGICAL BIOMARKER TO DISCRIMINATE AOSD FROM SEPSIS [AOSD is more commonly known as Still's Disease.]

SERUM ADIPOKINE (ADIPONECTIN, LEPTIN, VISFATIN, AND RESISTIN) LEVELS IN PATIENTS WITH RHEUMATOID ARTHRITIS ARE DIFFERENTIALLY MODULATED BY DISEASE ACTIVITY BUT MAY NOT CONTRIBUTE TO TREATMENT RESISTANCE

THE SOLUBLE FORM OF CD18 IS ASSOCIATED WITH CLINICAL FINDINGS, CRP AND MRI ACTIVITY IN SPONDYLOARTHRITIS

SECRETED FRIZZLED-RELATED PROTEIN 5 INHIBITS EXPRESSION OF PRO-INFLAMMATORY MEDIATORS BY DOWN-REGULATION OF JNK IN RHEUMATOID ARTHRITIS

A NOVEL PHARMACOPROTEOMIC STUDY CONFIRMS THE SYNERGISTIC CHONDROPROTECTIVE EFFECT OF CHONDROTIN SULFATE AND GLUCOSAMINE HYDROCHLORIDE.

A SIMPLIFIED METHOD TO DETERMINE JOINT LOADING AS A SURROGATE MARKER OF PAIN/DISABILITY IN A CANINE MODEL OF OSTEOARTHRITIS, VALIDATED USING FORCE PLATE ANALYSES AS A GOLD STANDARD.

INTRA-ARTICULAR GLUCOCORTICOID INJECTIONS DECREASE THE NUMBER OF STEROID HORMONE RECEPTOR POSITIVE CELLS IN SYNOVIAL TISSUE OF PATIENTS WITH PERSISTENT KNEE ARTHRITIS

REBAMIPIDE ATTENUATES PAIN SEVERITY AND CARTILAGE DEGENERATION IN A RAT MODEL OF OSTEOARTHRITIS BY DOWNREGULATING OXIDATIVE DAMAGE AND CATABOLIC ACTIVITY IN CHONDROCYTES

IMPAIRED HEALING OF ANTERIOR CRUCIATE LIGAMENT CORRELATES WITH KININS EXPRESSION

REGULATION OF SOCS1, SOCS2 AND SOCS3 EXPRESSION IN PATIENTS WITH EARLY ARTHRITIS.

THERAPY RESPONSE IN RHEUMATOID ARTHRITIS PATIENTS AND CONCOMITANT FIBROMYALGIA

FREQUENCY OF FIBROMYALGIA IN PATIENTS WITH SPONDYLOARTHRITIS

DELAY ON FIBROMYALGIA DIAGNOSIS AND ITS IMPACT ON LONG TERM OUTCOMES

FIBROMYALGIA IN EGYPTAN PATIENTS ON HAEMODIALYSIS. DOES HEPATITIS C VIRAL INFECTION HAS A ROLE? [yeah I know the word has should be have in order to have sub/verb agreement]

STUDY ON FACTORS ASSOCIATED WITH CHRONIC FATIGUE SYNDROME (FIBROMYALGIA) IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS [on this idk why they say assoc w/CFS then have fibro in parentheses. CFS and fibro aren't the same and interchangeable so not sure what that's about]

OVERACTIVE LIFESTYLE IN PATIENTS WITH FIBROMYALGIA AS A CORE FEATURE OF BIPOLAR SPECTRUM DISORDER

SURGICAL INTERVENTIONS OF THE CERVICAL AND/OR LUMBAR SPINE IN PATIENTS WITH FIBROMYALGIA

OBESITY AND INSULIN RESISTANCE IN FIBROMYALGIA PATIENTS

OBESITY AND FIBROMYALGIA: RELATIONSHIP BETWEEN BODY MASS INDEX AND SEVERITY OF THE SYMPTOMS

CLUSTER ANALYSIS OF CLINICAL DATA IDENTIFIES FIBROMYALGIA SUBGROUPS

MEDIATION OF CHILDHOOD/ADOLESCENCE MALTREATMENT AND ADULT FIBROMYALGIA SYNDROME BY DEPRESSION – A CASE CONTROL STUDY

THE INFLUENCE OF WEATHER ON DAILY PAIN AND FATIGUE IN FEMALE PATIENTS WITH FIBROMYALGIA [seems interesting. I fully believe weather influences both FMS and RA symptoms, but some docs still deny it]

EFFECTS OF A ONE WEEK MULTIDISCIPLINARY INPATIENT SELF-MANAGEMENT PROGRAMME FOR PATIENTS WITH FIBROMYALGIA: A RANDOMISED CONTROLLED TRIAL [I am a BIG believer in self-management programs.]

CONCOMITANT FIBROMYALGIA AND DEPRESSION MIGHT BE A CAUSE OF DISCREPANCY BETWEEN BOOLEAN REMISSION AND DAS28 REMISSION IN RHEUMATOID ARTHRITIS

ASSESSMENT OF ART THERAPY PROGRAM FOR WOMEN WITH FIBROMYALGIA: RANDOMIZED, CONTROLLED, BLINDED STUDY

DAS-28, SDAI AND CDAI IN THE PATIENTS WITH RHEUMATOID ARTHRITIS AND CONCOMITANT FIBROMYALGIA

SIMILARITIES BETWEEN FIBROMYALGIA AND CHRONIC FATIGUE SYNDROME: A SINGLE DISEASE? [after my earlier comment I found this one!]

ADHERENCE AND EFFECTIVENESS OF A SIMPLE PROGRAM OF HOME-MADE STRETCHING IN FIBROMYALGIA

SMOKING IS ASSOCIATED WITH REDUCED IGF-1 LEVELS AND HIGHER PAIN EXPERIENCE IN PATIENTS WITH FIBROMYALGIA

MONOTHERAPY VERSUS COMBINATION THERAPY IN THE TREATMENT OF FIBROMYALGIA

BENEFITS OF A MULTIDISCIPLINARY TREATMENT IN WOMEN WITH FIBROMYALGIA AND OBESITY

THE EFFECTIVENESS OF SHIATSU ON PAIN, SLEEP QUALITY AND BALANCE CONFIDENCE OF FIBROMYALGIA PATIENTS: A CONTROLLED CLINICAL TRIAL

FATIGUE IN RHEUMATOID ARTHRITIS PATIENTS: THE IMPACT OF DISEASE ACTIVITY, PAIN, DISABILITY AND DEPRESSIVE DISORDERS

NEUROPATHIC PAIN IN PATIENTS WITH SYSTEMIC SCLEROSIS

NEGATIVE LIFE EVENTS BEFORE THE DISEASE ONSET AND DISEASE OUTCOME IN LONG TERM FOLLOW UP OF PAIN, SLEEP, FATIGUE AND GENERAL WELL-BEING

ATTENTIONAL IMPAIRMENT IN CHRONIC CENTRAL AND PERIPHERAL PAIN: CONTROLLED STUDY


DETECTION OF SYNOVITIS, BONE EROSIONS, AND BONE MARROW OEDEMA IN PATIENTS WITH INFLAMMATORY HAND PAIN - A COMPARISON OF LOW FIELD MRI AND HIGH FIELD MRI.

PREDICTIVE VALUE OF ULTRASOUND ON THE RESPONSE TO STEROID INFILTRATIONS IN THE PAINFUL SHOULDER: A PROSPECTIVE CONTROLLED SINGLE-BLIND STUDY OF 70 PATIENTS

COMPARISON OF AGREEMENT AND RESPONSIVENESS TO TREATMENT EFFECTS OF 100MM VISUAL ANALOG SCALE AND 11 POINT NUMERICAL RATING SCALE TO ASSESS WRIST PAIN IN PATIENTS WITH RHEUMATOID ARTHRITIS.

PREDICTORS OF OUTCOME OF MULTIDISCIPLINARY TREATMENT IN CHRONIC WIDESPREAD PAIN: AN OBSERVATIONAL STUDY

POORER POSTURAL CONTROL OF PATIENTS WITH LOW BACK PAIN COMPARED TO A CONTROL GROUP

THE EFFECT OF CUSTOMIZED INSERTS ON PAIN, PHYSICAL FUNCTION AND QUALITY OF LIFE IN RHEUMATOLOGICAL PATIENTS WITH FOOT PAIN

THE RELATIONSHIP BETWEEN PAIN, PHYSICAL ACTIVITY AND FUNCTIONAL STATUS IN PATIENTS WITH KNEE OSTEOARTHRITIS

THE EFFECTS OF LOW BACK PAIN ON QUALITY OF LIFE AND FUNCTIONAL DISABILITY IN NURSES WITH LOW BACK PAIN

A GRIP FORCE OVER 104 NEWTON IS ASSOCIATED TO LESS ACTIVITY LIMITATIONS AND PAIN IN WOMEN WITH HAND OSTHEOARTHRATIS

PAIN MANAGEMENT: OBSERVATION AND SIDE EFFECTS - FRENCH SITUATION

A LARGE RANDOMISED, CONTROLLED TRIAL COMPARING THE EFFICACY AND SAFETY OF TOPICAL KETOPROFEN IN TRANSFERSOME GEL WITH ORAL CELECOXIB FOR OSTEOARTHRITIS KNEE PAIN

THE ASSOCIATION BETWEEN PAIN AND ULTRASONOGRAPHIC FEATURES OF HAND OSTEOARTHRITIS IN FINGER JOINTS

PAIN, HEALTH-RELATED QUALITY OF LIFE AND HEALTH STATUS IN GOUT IN EUROPE

BODY MASS INDEX AND DEPRESSION ARE INDEPENDENTLY ASSOCIATED WITH KNEE PAIN AND ACTIVITY LIMITATIONS IN KNEE OSTEOARTHRITIS: RESULTS FROM THE AMS-OA COHORT

PAIN SCORES ARE THE PRIMARY EXPLANATORY VARIABLE FOR HIGHER GLOBAL ESTIMATES BY PATIENTS COMPARED TO DOCTORS IN PATIENTS WITH ALL RHEUMATIC DISEASES


ASSESSMENT OF POSTURAL CONTROL, STRENGHT OF LOWER LIMBS A COMPARISON OF INFLAMMATORY BACK PAIN CRITERIA AS DIAGNOSTIC TOOL IN ANKYLOSING SPONDYLITIS AND EARLY AXIAL SPONDYLOARTHRITIS

ND PAIN IN INDIVIDUALS WITH AND WITHOUT FIBROMYALGIA


EFFICACY AND SAFETY OF DICLOFENAC DIETHYLAMINE 1.16% GEL IN THE TREATMENT OF ACUTE NECK PAIN: A RANDOMIZED, DOUBLE-BLIND, PLACEBO-CONTROLLED STUDY

NO PROSPECTIVE ASSOCIATION FOUND BETWEEN OBESITY AND CHRONIC, WIDESPREAD MUSCULOSKELETAL PAIN IN A POPULATION BASED 20-YEAR PROSPECTIVE FOLLOW-UP STUDY

IDENTIFICATION OF AXIAL SPONDYLOARTHRITIS AMONG PATIENTS WITH CHRONIC BACK PAIN IN PRIMARY CARE – DOES DETERMINATION OF HLA B27 IMPROVE THE PERFORMANCE OF CLINICAL ASSESSMENTS OF INFLAMMATORY BACK PAIN ?

IMPACT OF UVEITIS ON THE PHENOTYPE OF PATIENTS WITH RECENT INFLAMMATORY BACK PAIN. DATA FROM THE DESIR COHORT.

RATIO OF NON-RADIOGRAPHIC AND RADIOGRAPHIC AXIAL SPONDYLOARTHRITIS IN PATIENTS REFERRED BECAUSE OF BACK PAIN IS DEPENDENT ON SYMPTOM DURATION

ASSOCIATION BETWEEN JOINT PAIN SEVERITY AND SERUM LEPTIN LEVELS IN HAND OSTEOARTHRITIS

MARKED BILATERAL SYMMETRICITY OF CARTILAGE DAMAGE, BONE MARROW LESIONS AND MENISCAL DAMAGE IN SUBJECTS WITH KNEE PAIN AND WITH OR WITHOUT RADIOGRAPHIC OSTEOARTHRITIS: THE JOG STUDY


FENOFIBRATE EFFECTS ON PAIN, FUNCTION, CYTOKINE PRODUCTION, AND CIRCULATING ENDOTHELIAL PROGENITOR CELLS IN PATIENTS WITH EROSIVE OSTEOARTHRITIS

BACK PAIN AND QUALITY OF LIFE: 18- AND 24-MONTH FINAL RESULTS FROM THE ITALIAN STUDY ON SEVERE OSTEOPOROSIS (ISSO)


QUALITY OF LIFE AND PAIN EVALUATION IN PATIENTS WITH AND WITHOUT SELF-REPORTED OSTEOPOROSIS - CORPO STUDY: COMPREHENDING OSTEOPOROSIS REAL PERCEPTION AND OVERVIEW

CHRONIC LOW BACK PAIN IN OSTEOPOROTIC FEMALES WITH RHEUMATOID ARTHRITIS A RANDOMIZED CLINICAL TRIAL


PREVALENCE AND SEVERITY OF INSOMNIA IN CHRONIC LOW BACK PAIN PATIENTS

SEXUAL LIFE IS MORE PERTURBED IN MEN THAN WOMEN SUFFERING FROM CHRONIC LOW BACK PAIN. RSULTS OF A CROSS SECTIONAL STUDY IN A MOROCCAN SAMPLE.

ARE FEMALES WITH RHEUMATOID ARTHRITIS CAUGHT IN A VICIOUS CIRCLE OF PAIN, FATIGUE AND SLEEP DISTURBANCE? [I'd be willing to be the answer is YES! And I was right.]

Sleep disturbance is to a higher degree reported by females and is independently associated with increased pain, fatigue and worse mental and physical function. Improving sleep quality may reduce RA impact of disease and should be addressed in daily clinical practice when treating patients with RA.

PAIN MANAGEMENT IN RHEUMATOLOGY– LESSONS FROM A PAIN IN MOTION: FROM THE JOINT TO THE BRAIN, FROM ANALGESICS TO BIOLOGICS.


OFTEN USED BUT RARELY INVESTIGATED: PSYCHOMETRIC PROPERTIES OF COMMON PAIN MEASURES IN RHEUMATOID ARTHRITIS – PRELIMINARY RESULTS FROM AN OUTPATIENT COHORT

ASSESSING NEUROPATHIC PAIN COMPONENTS IN PATIENTS WITH RHEUMATOID ARTHRITIS

THE THRESHOLD OF PAIN IN PATIENTS AFFECTED BY RHEUMATOID ARTHRITIS CORRELATES WITH ESR BUT NOT WITH ULTRASOUND SCORE.

IMPROVED PHYSICAL FUNCTION, PAIN, AND HEALTH RELATED QUALITY OF LIFE WITH CERTOLIZUMAB PEGOL IN JAPANESE RHEUMATOID ARTHRITIS PATIENTS WITH AN INADEQUATE RESPONSE TO METHOTREXATE: RESULTS FROM THE JRAPID STUDY

HEALTH-RELATED QUALITY OF LIFE (HRQOL) BENEFITS ASSOCIATED WITH REDUCTIONS IN DISEASE ACTIVITY AND PAIN SEVERITY AMONG RHEUMATOID ARTHRITIS (RA) PATIENTS TREATED WITH SECUKINUMAB [I've not heard of secukinumab but I checked Wiki and it says

Secukinumab is a human monoclonal antibody designed for the treatments of uveitis, rheumatoid arthritis, and psoriasis. It targets member A from the cytokine family of interleukin 17.

NANO-FORMULATED LOWER DOSE NSAIDS PREFERRED BY PATIENTS EXPERIENCING ACUTE PAIN

PAIN CATASTROPHIZING AND PAIN ANXIETY ARE ASSOCIATED WITH PAIN SEVERITY AND WITH BOTH NEUROPATHIC AND FIBROMYALGA PAIN PHENOTYPES IN PSS PATIENTS

RELATIONSHIP BETWEEN CHRONIC LOW BACK PAIN AND MRI OF SACROILIAC JOINTS

INFLUENCE OF ENTHESITIS PAIN ON ANKYLOSING SPONDYLITIS DISEASE ACTIVITY SCORE (ASDAS)

LONG TERM TOLERABILITY AND EFFECTIVENESS OF A SINGLE INJECTION OF 6ML HYLAN G-F 20 IN 451 PATIENTS WITH KNEE OSTEOARTHRITIS PAIN

MOVES: MAGNITUDE OF OSTEOARTHRITIS DISADVANTAGE ON PEOPLE'S LIVES: PAIN IN SELF-REPORTED OSTEOARTHRITIS

BISPHOSPHONATE INTRAVENOUS ALLOWS A RAPID CONTRAST OF PAIN IN COMPLEX REGIONAL PAIN SYNDROME (CRPS)

EFFICACY AND SAFETY OF STEROID INJECTIONS FOR SHOULDER PAIN

EFFECTIVENESS OF FACET JOINT INJECTION IN LOW BACK PAIN [This intrigues me because I've had the facet joint injections before we burnt the nerves off. I know the blocks I had were supposed to be short-acting, but for me I had a longer length of relief than we ever thought would happen.]


MULTIDISCIPLINARY REHABILITATION IN CHRONIC LUMBAR PAIN : LONG-TERM EFFECT ON WORK STATUS.


PRESSURE PAIN THRESHOLD AND PAIN COPING STRATEGIES IN JUVENILE IDIOPATHIC ARTHRITIS: A CROSS-SECTIONAL STUDY

MUSCULO-SKELETAL PAIN AND JOINT HYPERMOBILITY IN CHILDREN: A COMPLEX RELATIONSHIP

EFFICACY AND SECURITY OF ANAKINRA TREATMENT IN PATIENTS WITH SYSTEMIC-ONSET JUVENIL IDIOPATHIC ARTHRITIS: "INITIAL RESULTS FROM A REGISTER OF TWO PEDIATRIC REUMATOLOGIC UNITS FROM SPAIN"

PERFORMANCE OF A PATIENT-BASED ONLINE-QUESTIONNAIRE TO IDENTIFY PATIENTS WITH AXIAL SPONDYLOARTHRITIS (SPA) IN PATIENTS WITH CHRONIC LOW BACK PAIN

LUMBAR FACET JOINT EFFUSION ON 3-D MR MYELOGRAPHY: A SIGN OF RHEUMATOID BACK PAIN?

MULTIMODAL TREATMENT IN A DAY CLINIC EFFECTS THE PAIN EXPERIENCE IN PATIENTS WITH RHEUMATIC DISEASES.

TALKING ABOUT SEXUALITY IN CHRONIC LOW BACK PAIN PATIENTS: BARRIERS AND PATIENT'S EXPECTATIONS

USING THE SF-MCGILL PAIN QUESTIONNAIRE, HOW DO PATIENTS WITH SLE DESCRIBE THEIR PAIN?

REFFECTS OF A YOGA PROGRAM ON PAIN RELIEF, REDUCING ANXIETY AND EXTENDED RANGE OF MOTION OF KNEE IN RHEUMATOID ARTHRITIS PATIENTS

INVESTIGATING THE EFFECT OF ETANERCEPT ON THE PERIPHERAL B CELL COMPARTMENT IN CHILDREN WITH JUVENILE IDIOPATHIC ARTHRITIS

JUVENILE-ONSET SYSTEMIC LUPUS ERYTHEMATOSUS (JSLE) MONOCYTES AND MACROPHAGES EXPRESS RAISED LEVELS OF RECEPTORS ASSOCIATED WITH APOPTOTIC CELL CLEARANCE

TOCILIZUMAB INCREASES HEMOGLOBIN PRODUCTION IN PATIENT WITH JUVENILE IDIOPATIC ARTHRITIS AND BETA THALASSEMIC TRAIT

LEPTIN CONCENTRATIONS AND RADIOLOGICAL PROGRESSION IN CHILDREN WITH JUVENILE IDIOPATHIC ARTHRITIS

DISABILITY IN ADULT PATIENTS WITH IDIOPATHIC JUVENILE ARTHRITIS


PRESSURE PAIN THRESHOLD AND PAIN COPING STRATEGIES IN JUVENILE IDIOPATHIC ARTHRITIS: A CROSS-SECTIONAL STUDY

JUVENILE IDIOPATHIC ARTHRITIS: CAN MOTHER MOOD BE A DETERMINANT FACTOR IN THE CHILD ILLNESS MANAGEMENT?

LEFLUNOMIDE IN THE TREATMENT OF CHRONIC UVEITIS IN JUVENILE IDIOPATHIC ARTHRITIS


EXPLORING THE RELATIONSHIPS BETWEEN ADULT JUVENILE IDIOPATHIC ARTHRITIS AND EMPLOYMENT


CORONARY ARTERY ABNORMALITIES IN CHILDREN WITH SYSTEMIC-ONSET JUVENILE IDIOPATHIC ARTHRITIS


JUVENILE IDIOPATHIC ARTHRITIS ENTHESITIS-RELATED ARTHRITIS (ERA) SUBTYPE: DO BOYS AND GIRLS HAVE A DIFFERENT CLINICAL FENOTYPE AND COURSE?

EQUIVALENCE OF DISEASE ACTIVITY TOOLS FOR JUVENILE IDIOPATHIC ARTHRITIS

8VITAMIN D STATUS IN PATIENTS WITH JUVENILE IDIOPATHIC ARTHRITIS

RADIOLOGICAL CERVICAL SPINE INVOLVEMENT IN JUVENILE IDIOPATHIC ARTHRITIS IN ADULTHOOD

HEPATITIS B IMMUNITY IN CHILDREN WITH JUVENILE IDIOPATHIC ARTHRITIS AT DISEASE ONSET.


THE QUALITY OF LIFE OF CHILDREN WITH JUVENILE IDIOPATHIC ARTHRITIS TREATED WITH ETANERCEPT IN COMBINATION WITH METHOTREXATE

EFFICACY AND SAFETY OF THERAPY BY ETANERCEPT IN COMBINATION WITH METHOTREXATE FOR PATIENTS WITH JUVENILE IDIOPATHIC ARTHRITIS

ASSOCIATION BETWEEN VITAMIN D DEFICIENCY AND DISEASE ACTIVITY IN JUVENILE IDIOPATHIC ARTHRITIS


HEALTH RELATED QUALITY OF LIFE IN PATIENTS WITH JUVENILE IDIOPATHIC ARTHRITIS

BIOLOGICAL THERAPY IN PATIENTS WITH CHRONIC JUVENILE IDIOPATHIC ARTHRITIS-ASSOCIATED UVEITIS: RESULTS OF FOLLOW-UP IN A MULTIDISCIPLINARY UNIT

CERTOLIZUMAB IN JUVENILE IDIOPATHIC ARTHRITIS (JIA): EXPERIENCE OF 12 PATIENTS TREATED

GOLIMUMAB IN 25 YOUNG ADULTS AFFECTED BY JUVENILE IDIOPATHIC ARTHRITIS (JIA) NON RESPONDERS TO OTHER BIOLOGICAL AGENTS: PRELIMINARY DATA.

PREDICTABLE AND UNEXPECTED EFFECTS OF TOCILIZUMAB IN PATIENTS WITH SYSTEMIC JUVENILE IDIOPATHIC ARTHRITIS
[I am glad to see that the newer meds are being studied in JIA kids. I know how scary it is for a parent to allow their child to be on a study drug, but it's an important thing for not only their child but others. If I were in that position, I'd likely not hesitate to try a study drug. But that may be due to the fact I was a study drug kid. For ibuprofen and naproxen.]

TUMOUR NECROSIS FACTOR-BLOCKING AGENTS IN PERSISTENT OLIGOARTICULAR JUVENILE IDIOPATHIC ARTHRITIS: RESULTS FROM THE DUTCH ARTHRITIS AND BIOLOGICALS IN CHILDREN REGISTER

POLYMORPHISMS OF D6S273 MICROSATELLITE: POTENTIAL BASIS FOR DIFFERENTIATING HLA-B27/B7 POSITIVE PATIENTS WITH POLYARTICULAR COURSE OF JIA FROM JUVENILE SPONDYLOARTHRITIS PATIENTS?

SAFETY AND EFFICACY OF A 12-MO CANAKINUMAB ADMINISTRATION IN PATIENTS WITH SYSTEMIC JUVENILE IDIOPATHIC ARTHRITIS: DATA FROM THE GREEK NATIONAL REGISTRY.

COMPARISON OF THE PREVALENCE OF PROXY- OR SELF-REPORTED SIDE EFFECTS OF METHOTREXATE ADMINISTERED ORALLY, SUBCUTANEOUSLY OR INTRAMUSCULARLY IN CHILDREN WITH JUVENILE IDIOPATHIC ARTHRITIS

SUBCLINICAL TEMPORO-MANDIBULAR JOINT (TMJ) INVOLVEMENT IN JUVENILE IDIOPATHIC ARTHRITIS (JIA) DETECT BY SCREENING IMAGING

EFFECTS OF INFLIXIMAB TREATMENT ON GROWTH IN CHILDREN WITH JUVENILE IDIOPATHIC ARTHRITIS (JIA).

SUSTAINED MAINTENANCE OF ADAPTED ACR PEDIATRIC RESPONSE WITH CANAKINUMAB IN PATIENTS WITH ACTIVE SYSTEMIC JUVENILE IDIOPATHIC ARTHRITIS
[Canakiumab is another new med for me.So went to Wiki again.

Canakinumab (INN, trade name Ilaris, previously ACZ885)[1] is a human monoclonal antibody targeted at interleukin-1 beta. It has no cross-reactivity with other members of the interleukin-1 family, including interleukin-1 alpha.[2] ...Canakinumab was being developed by Novartis for the treatment of rheumatoid arthritis but this trial has been discontinued.[5] Canakinumab is also in phase I clinical trials as a possible treatment for chronic obstructive pulmonary disease.[6]

MACROPHAGE ACTIVATION SYNDROME AS THE PRESENTING MANIFESTATION OF SYSTEMIC JUVENILE ARTHRITIS: UNICENTER STUDY OF CLINICAL FEATURES AND OUTCOME IN 12 PATIENTS

EPIDEMIOLOGY OF JUVENILE IDIOPATHIC ARTRITIS-ASSOCIATED UVEITIS IN SPAIN: RESULTS FROM A NATIONAL REGISTRY

TOTAL HIP REPLACEMENT IN YOUNG PATIENTS WITH JUVENILE IDIOPATHIC ARTHRITIS

ASPECTS OF TEMPOROMANDIBULAR JOINT ARTHRITIS-RELATED OROFACIAL SYMPTOMS IN JUVENILE IDIOPATHIC ARTHRITIS

JUVENILE IDIOPATHIC ARTHRITIS: ATTITUDE OF PARENTS TO THE CHILD'S DISEASE

JUVENILE IDIOPATHIC ARTHRITIS: INTERACTION OF ATTITUDE OF PARENTS AND CHILDREN TO THE DISEASE

EFFECT OF PSYCHOLOGICAL PECULIARITIES OF PERSONALITY OF PATIENTS WITH JUVENILE IDIOPATHIC ARTHRITIS ON SELF-APPRAISAL OF QUALITY OF LIFE

ASSESSMENT OF QUALITY OF LIFE OF PATIENTS WITH JUVENILE IDIOPATHIC ARTHRITIS WITH AID OF QUESTIONNAIRE CHQ

DEVELOPMENT OF CUT-OFF VALUES FOR HIGH DISEASE ACTIVITY IN JUVENILE IDIOPATHIC ARTHRITIS BASED ON THE JUVENILE ARTHRITIS DISEASE ACTIVITY SCORE (JADAS)

PRELIMINARY ACTIVITY AND SEVERITY CRITERIA FOR JUVENILE IDIOPATHIC ARTHRITIS-RELATED UVEITIS

SAFETY AND EFFICACY OF ADALIMUMAB IN CHILDREN WITH ACTIVE POLYARTICULAR JUVENILE IDIOPATHIC ARTHRITIS AGED 2 TO <4 YEARS OR ≥4 YEARS WEIGHING <15 KG

EFFICACY AND SAFETY OF RITUXIMAB RETREATMENT IN REFRACTORY SYSTEMIC JUVENILE IDIOPATHIC ARTHRITIS

DOES EXCLUSION OF THE ESR FROM JADAS AFFECT VALIDITY IN THE CLINICAL SETTING IN ASSESSMENT OF NEW-ONSET JUVENILE INFLAMMATORY ARTHRITIS?

TRANSITION TO ADULTHOOD, PROFESSIONAL AND SOCIAL OUTCOME OF JUVENILE IDIOPATHIC ARTHRITIS (JIA) PATIENTS: A FRENCH MULTICENTRIC STUDY BASED ON 353 PATIENTS.

RESULTS OF A MULTINATIONAL SURVEY REGARDING THE DEFINITION OF REMISSION IN JUVENILE IDIOPATHIC ARTHRITIS RELATED UVEITIS.

QUALITY OF LIFE OF JUVENILE IDIOPATHIC ARTHRITIS COHORT AT ADULTHOOD IN A TRANSITION PROGRAM

CLINICAL REMISSION IN 291 JUVENILE IDIOPATHIC ARTHRITIS PATIENTS TREATED WITH BIOLOGICAL AGENTS

OPG/RANK/RANKL IN PATHOGENESIS OF OSTEOPOROSIS OF JUVENILE IDIOPATHIC ARTHRITIS (JIA) SUBTYPES

RADIOLOGICAL PERIPHERAL INVOLVEMENT AT HANDS, FEET AND HIPS IN YOUNG ADULTS WITH POLYARTICULAR IDIOPATHIC JUVENILE ARTHRITIS.

6DRUG SURVIVAL AND REASONS FOR DISCONTINUATION OF THE FIRST COURSE OF BIOLOGICAL THERAPY IN 301 JUVENILE IDIOPATHIC ARTHRITIS PATIENTS.

ACHIEVEMENT OF CLINICAL REMISSION IN PATIENTS WITH JUVENILE IDIOPATHIC ARTHRITIS AFTER A LONG-TERM (2 - 5 YEARS) ETANERCEPT EXPOSURE: A NATIONAL REFERRAL CENTER'S EXPERIENCE. (PRELIMINARY REPORT).

DOES INTENSE SYNOVIAL ENHANCEMENT IN TEMPOROMANDIBULAR JOINTS OF JUVENILE IDIOPATHIC ARTHRITIS PATIENTS CORRELATE WITH DISEASE ACTIVITY?

WHAT HAPPENS WHEN ETANERCEPT IS DISCONTINUED IN "REMISSION" IN PATIENTS WITH JUVENILE IDIOPATHIC ARTHRITIS?

THE EFFICACY AND SAFETY OF IBANDRONIC ACID FOR INTRAVENOUS ADMINISTRATION FOR TREATMENT OF SEVERE SYSTEMIC OSTEOPOROSIS IN PATIENTS WITH JUVENILE ARTHRITIS

SAFETY AND EFFICACY OF TOCILIZUMAB THERAPY IN CHILDREN WITH SYSTEMIC ONSET OF JUVENILE IDIOPATHIC ARTHRITIS

HIGH PREVALENCE OF HAND AND WRIST IMPAIRMENTS IN JUVENILE IDIOPATHIC ARTHRITIS (JIA)

GLYCOSYLATION OF VITAMIN D BINDING PROTEIN REDUCED IN JUVENILE IDIOPATHIC ARTHRITIS PATIENTS AT RISK OF DISEASE EXTENSION

HOW TO TREAT JUVENILE IDIOPATHIC ARTHRITIS AND OTHER PAEDIATRIC RHEUMATIC DISEASES

THE YOUNG ADULT WITH JUVENILE IDIOPATHIC ARTHRITIS - KEY CLINICAL ISSUES

LONG-TERM SAFETY OF ADALIMUMAB IN PATIENTS FROM GLOBAL CLINICAL TRIALS IN RHEUMATOID ARTHRITIS, JUVENILE IDIOPATHIC ARTHRITIS, ANKYLOSING SPONDYLITIS, PSORIATIC ARTHRITIS, PSORIASIS, AND CROHN'S DISEASE

EFFICACY AND SAFETY OF ADALIMUMAB TREATMENT FOR REFRACTORY JUVENILE IDIOPATHIC ARTHRITIS – ASSOCIATED UVEITIS.

TOCILIZUMAB-EFFECTS ON GROWTH IMPAIRMENT IN SYSTEMIC JUVENILE IDIOPATHIC ARTHRITIS

PREDICTORS OF ACHIEVEMENT OF INACTIVE DISEASE IN CHILDREN WITH JUVENILE IDIOPATHIC ARTHRITIS TREATED WITH ETANERCEPT

DMARD USE IN THE TREATMENT OF JUVENILE IDIOPATHIC ARTHRITIS: A CROSS-SECTIONAL ANALYSIS OF THE CHILDHOOD ARTHRITIS AND RHEUMATOLOGY RESEARCH ALLIANCE (CARRA) REGISTRY

DO SERUM BIOMARKERS OF BONE AND OF CARTILAGE DEGRADATION REFLECT STRUCTURAL DAMAGE IN JUVENILE IDIOPATHIC ARTHRITIS (JIA)?

A WAITLIST CONTROLLED TRIAL OF THE EFFICACY OF A PSYCHOLOGICAL TREATMENT PROGRAM FOR CHILDREN WITH JUVENILE IDIOPATHIC ARTHRITIS AND THEIR PARENTS

INCIDENCE OF SELECTED OPPORTUNISTIC INFECTIONS AMONG CHILDREN WITH JUVENILE IDIOPATHIC ARTHRITIS

PREDICTORS OF POOR GROWTH IN CHILDREN WITH EARLY JUVENILE IDIOPATHIC ARTHRITIS: RESULTS FROM THE CHILDHOOD ARTHRITIS PROSPECTIVE STUDY (CAPS)

HIGHER DISEASE ACTIVITY AND EARLIER ARTHRITIS ONSET ARE ASSOCIATED WITH RISK OF CORONARY HEART DISEASE DEVELOPMENT IN PATIENTS WITH PSORIATIC ARTHRITIS

INCREASED RISK OF DIASTOLIC HEART FAILURE IN RA – WHAT SHOULD WE SCREENING FOR ?

INCREASED RATE OF DIASTOLIC HEART FAILURE IN RHEUMATOID ARTHRITIS CORRELATES WITH SYSTEMIC INFLAMMATION AND PERSISTENT DISEASE ACTIVITY, INDEPENDENT FROM TREATMENT STRATEGY

DEPRESSIVE SYMPTOMS AND HEART RATE VARIABILITY IN PATIENTS WITH FIBROMYALGIA

PREVALENCE AND PREDICTIVE ROLE OF TRADITIONAL CARDIOVASCULAR RISK FACTORS IN A COHORT OF SJÖGREN'S SYNDROME PATIENTS

CARDIOVASCULAR DISEASE IS RELATED TO DISEASE ACTIVITY IN ANKYLOSING SPONDYLITIS

COMPARISON OF EUROPEAN SCORE AND TWO NATIONAL GUIDELINES CALIBRATED FOR CARDIOVASCULAR RISK ASSESSMENT IN PATIENTS WITH PSORIATIC ARTHRITIS

HIGH FREQUENCY OF CARDIOVASCULAR DISEASE IN PATIENTS WITH KNEE OSTEOARTHRITIS IN A PRIMARY CARE SETTING

THE RISK OF CARDIOVASCULAR EVENTS IS INCREASED IN PEOPLE WITH GLUCOCORTICOID-INDUCED LIPODYSTROPHY

RHEUMATIC DISEASES AND CARDIOVASCULAR RISK: IMPLICATIONS FOR CLINICAL PRACTICE


PICTURING THE PROBLEM: CARDIOVASCULAR DISEASE IMPACT IN INFLAMMATORY RHEUMATIC DISEASES


SCREENING AND ASSESSING CARDIOVASCULAR RISK IN INFLAMMATORY ARTHRITIS


WHY IS CARDIOVASCULAR TRAINING IMPORTANT IN PEOPLE WITH RHEUMATIC DISEASE?

IMPLEMENTATION OF EFFECTIVE CARDIOVASCULAR TRAINING PRINCIPLES IN DAILY PRACTICE

ASSOCIATION OF ACID PHOSPHATASE LOCUS 1*C ALLELE WITH THE RISK OF CARDIOVASCULAR EVENTS IN RHEUMATOID ARTHRITIS PATIENTS

REDUCED ENDOTHELIUM-INDEPENDENT VASCULAR REACTIVITY IS INDICATIVE OF CAROTID ATHEROSCLEROSIS IN PATIENTS WITH RHEUMATOID ARTHRITIS WITHOUT OVERT CARDIOVASCULAR DISEASE

USE OF CARDIOVASCULAR DRUGS IN PATIENTS WITH RA, OVERALL AND IN PATIENTS WITH A HISTORY OF ACUTE ISCHEMIC CARDIAC EVENTS

ASSESSING THE CARDIOVASCULAR RISK BURDEN IN PATIENTS WITH RHEUMATOID ARTHRITIS: ROLE OF ANNUAL REVIEW CLINIC
CARDIOVASCULAR SAFETY FINDINGS IN RHEUMATOID ARTHRITIS PATIENTS TREATED WITH TOFACITINIB (CP-690,550), A NOVEL, ORAL JAK INHIBITOR

HIGH RATE OF CARDIOVASCULAR EVENTS IN LUPUS PATIENTS AT 5 YEAR FOLLOW UP AND ASSOCIATION OF CLASSICAL AND LUPUS RELATED RISK FACTORS

FUNCTIONAL VARIANT IN THE IFNG GENE PREDISPOSES TO CARDIOVASCULAR RISK IN RHEUMATOID ARTHRITIS PATIENTS

WHO SHOULD CONTROL THE CLASSICAL CARDIOVASCULAR RISK FACTORS IN THE RHEUMATOID ARTHRITIS? STUDY ON THE CONSISTENCY BETWEEN PRIMARY CARE AND RHEUMATOLOGY

PREDICTORS OF OVERALL/CARDIOVASCULAR MORTALITY IN PATIENTS WITH EARLY INFLAMMATORY POLYARTHRITIS; THE LIPID-PARADOX?

USE OF ANTI-TNF THERAPY IS ASSOCIATED WITH REDUCED CARDIOVASCULAR EVENT RISK IN RHEUMATOID ARTHRITIS

EXERCISE ON STATIONARY BIKES IN PATIENTS WITH RHEUMATOID ARTHRITIS: POSITIVE EFFECTS ON CARDIOVASCULAR RISK FACTORS.

IMPACT OF ERGOMETRIC TEST IN PATIENTS WITH RHEUMATOID ARTHRITIS, ANKYLOSING SPONDYLITIS AND SYSTEMIC LUPUS ERYTHEMATOSUS, WITHOUT CARDIOVASCULAR SYMPTOMS, BEFORE STARTING A SUPERVISED PHYSICAL ACTIVITY PROGRAM

DOES CARDIOVASCULAR DISEASE INCREASE THE RISK OF SICK LEAVE AND WORK DISABILITY AMONG PATIENTS WITH RHEUMATIC DISEASE?

EVALUATION OF EARLY MARKERS OF CARDIOVASCULAR RISK IN SUBJECTS AFFECTED BY SYSTEMIC RHEUMATIC DISEASES

THE EFFECT OF ADALIMUMAB ON RISK OF MAJOR ADVERSE CARDIOVASCULAR EVENTS IN RHEUMATOID ARTHRITIS: A META-ANALYSIS OF RANDOMIZED TRIALS

TNF-BLOCKING THERAPY REDUCES CARDIOVASCULAR DISEASE AND RISK FACTORS IN RHEUMATOID ARTHRITIS

RISK FACTORS FOR MAJOR ADVERSE CARDIOVASCULAR (CV) EVENTS (MACE) IN RHEUMATOID ARTHRITIS (RA) PATIENTS TREATED WITH TOCILIZUMAB (TCZ)

EVALUATION OF THE USE OF THE CARDIOVASCULAR RISK SCORE TABLES IN PATIENTS WITH RHEUMATOID ARTHRITIS

RHEUMATOID ARTHRITIS PATIENTS WITH HIGHER DISEASE SEVERITY AND SUBCLINICAL CAROTID PLAQUE EXPERIENCE MORE CARDIOVASCULAR EVENTS DESPITE A FAVORABLE CONVENTIONAL CADIOVASCULAR RISK PROFILE

IMPROVEMENT IN SOME, BUT NOT ALL, SURROGATE MEASURES OF CARDIOVASCULAR DISEASE FOLLOWING INTENSIVE TREATMENT OF EARLY RHEUMATOID ARTHRITIS.

NON-STEROIDAL ANTI-INFLAMMATORY DRUG USE AND THE RISK OF CARDIOVASCULAR DISEASE IN PATIENTS WITH RHEUMATOID ARTHRITIS - IS THERE A RISK ?

PREDICTING CARDIOVASCULAR DISEASE IN RHEUMATOID ARTHRITIS: THE EFFECT OF LONG-TERM STORAGE ON MEASURED CHOLESTEROL LEVELS IN FROZEN SERUM SAMPLES.

SUSTAINED DEVELOPMENT OF CARDIOVASCULAR DISEASE IN RHEUMATOID ARTHRITIS DESPITE CARDIOPROTECTIVE TREATMENT: THE 7-YEAR PROSPECTIVE CARRE-STUDY

IS CARDIOVASCULAR MORBIDITY AND MORTALITY INCREASED IN WORKING INDIVIDUALS WITH INFLAMMATORY RHEUMATIC DISEASES?

SUBSTANTIAL SUBCLINICAL CARDIOVASCULAR DYSFUNCTION IN INFLAMMATORY ARTHRITIS

DISH PREVALENCE IN PATIENTS AFFECTED BY SEVERE CARDIOVASCULAR DISEASES

ASSOCIATION BETWEEN CARDIOVASCULAR EVENTS AND CLASSIC CARDIOVASCULAR RISK FACTORS AND DISEASE CHARACTERISTICS IN PATIENTS WITH RHEUMATOID ARTHRITIS

THE CAROTID ARTERY ATHEROSCLEROSIS BURDEN AND ITS ASSOCIATED CARDIOVASCULAR RISK FACTORS IN AFRICAN BLACK AND CAUCASIAN PATIENTS WITH ESTABLISHED RHEUMATOID ARTHRITIS

CARDIOVASCULAR RISK IN RHEUMATOID ARTHRITIS: ARE WE AWARE?

CARDIOVASCULAR RISK FACTORS AND THEIR ASSOCIATION WITH BONE METABOLISM AND DISEASE ACTIVITY IN PATIENTS WITH EARLY ARTHRITIS

CARDIOVASCULAR RISK ASSESSMENT IN RHEUMATOID ARTHRITIS PATIENTS USING THE SCORE CHART


NUMBER OF CARDIOVASCULAR RISK FACTORS MAY BE ASSOCIATED WITH HIGHER DISEASE ACTIVITY SEVERITY. EXPLORATORY ANALYSIS OF BASELINE DATA FROM THE CANADIAN MTX AND ETANERCEPT OUTCOME STUDY: A RANDOMIZED TRIAL OF ETANERCEPT AND MTX VS ETANERCEPT ALONE IN RA

INFLUENCE OF MHCIITA RS3087456 AND RS4774 POLYMORPHISMS IN THE SUSCEPTIBILITY TO CARDIOVASCULAR DISEASE OF PATIENTS WITH RHEUMATOID ARTHRITIS

VALIDATION OF ICD-10 CODES FOR STROKE IN PATIENTS WITH RHEUMATOID ARTHRITIS

RHEUMATOLOGISTS PLAY A KEY ROLE IN SHARED DECISION-MAKING WITH PATIENTS IN THE CHOICE TO INITIATE BIOLOGIC THERAPY FOR TREATMENT OF RHEUMATOID ARTHRITIS

REMISSION RATES INCREASE SUBSTANTIALLY BY ADDING ADALIMUMAB TO METHOTREXATE AND INTRA-ARTICULAR GLUCOCORTICOID IN PATIENTS WITH EARLY RHEUMATOID ARTHRITIS - 1-YEAR RESULTS OF INVESTIGATOR-INITIATED, DOUBLE-BLINDED RANDOMIZED CLINICAL TRIAL (OPERA)

INDUCTION THERAPY WITH ADALIMUMAB PLUS METHOTREXATE VERSUS METHOTREXATE MONOTHERAPY IN RECENT ONSET RHEUMATOID ARTHRITIS (RA) – AN INVESTIGATOR INITIATED RANDOMIZED CONTROLLED TRIAL

TARGETED TREATMENT WITH COMBINATION DMARDS PRODUCES EXCELLENT CLINICAL AND RADIOGRAPHIC LONG-TERM OUTCOMES IN EARLY RHEUMATOID ARTHRITIS REGARDLESS OF INITIAL INFLIXIMAB. THE 5-YEAR FOLLOW-UP RESULTS OF THE NEO-RACO TRIAL.

TREATMENT PATTERNS IN PSORIATIC ARTHRITIS (PSA) PATIENTS NEWLY INITIATED ON ORAL DISEASE-MODIFYING ANTI-RHEUMATIC DRUGS (DMARDS)

POTENTIALLY HARMFUL PRESCRIPTION OF NSAIDS IN A PRIMARY CARE POPULATION WITH MUSCULOSKELETAL COMPLAINTS

DEVELOPMENT OF A HEALTH INDEX TO ASSESS THE BURDEN OF DISEASE IN PATIENTS WITH ANKYLOSING SPONDYLITIS – FIRST STEPS OF A GLOBAL INITIATIVE BASED ON THE ICF GUIDED BY ASAS

THE NEGATIVE EFFECTS OF GLUCOCORTICOIDS ON BONE ARE PRIMARILY MEDIATED BY GENES INVOLVED IN OSTEOBLAST DIFFERENTIATION AND BONE REMODELLING

SINOVIAL FLUID CYTOKINES RATHER THAN SYNOVIAL INFLAMMATORY CELL INFILTRATES MAY DIFFERENTIATE RHEUMATOID ARTHRITIS ACCORDING TO THE ACPA STATUS

THE USEFULNESS OF A MUSCULOSKELETAL ULTRASOUND (MUS) SCORING SYSTEM FOR 22 HAND JOINTS EXAMINATION FOR THE DETECTION OF EARLY UNDIFFERENTIATED INFLAMMATORY ARTHRITIS AND TREATMENT DECISIONS MAKING IN ESTABLISHED INFLAMMATORY ARTHRITIS.

PREDICTIVE VALUE OF EXERCISE STRESS TEST (24H TEST&RE-TEST) AND COGHEALTH© IN DIFFERENTIAL DIAGNOSIS OF CHRONIC FATIGUE SYNDROME VS. FIBROMYALGIA

RESPONSE TO ABATACEPT AND TOCILIZUMAB IN PATIENTS WHO HAD FAILED RITUXIMAB– INITIAL SINGLE CENTRE EXPERIENCE

REMISSION AFTER ONE YEAR FOLLOW UP OF THE IMPROVED-STUDY, A RANDOMIZED CLINICAL TRIAL AIMING AT REMISSION IN PATIENTS WITH EARLY RHEUMATOID AND UNDIFFERENTIATED ARTHRITIS.

RISK FACTORS OF INTERSTITIAL LUNG DISEASE IN PATIENTS WITH RHEUMATOID ARTHRITIS.

DIFFERENTIAL IMPACT OF TRADITIONAL CARDIAC RISK FACTORS ON CORONARY PLAQUE PREVALENCE IN CORONARY ARTERY DISEASE (CAD)-NAÏVE SUBJECTS WITH RHEUMATOID ARTHRITIS COMPARED TO CONTROLS

FACTORS ASSOCIATED WITH SERUM IL-6 LEVELS IN PATIENTS WITH EARLY ARTHRITIS.

IL-6 BLOCKADE ENHANCES THE THERAPEUTIC EFFECT OF STEROIDS

LOW DOSE METHOTREXATE PROTECTS RHEUMATOID ARTHRITIS BONE MASS AGAINST CORTICOSTEROID INDUCED BONE LOSS
INFLUENCE OF DOSE TITRATION OF CONCOMITANT STEROID AND METHOTREXATE DURING BIOLOGIC THERAPY ON REMISSION RATES IN PATIENTS WITH RHEUMATOID ARTHRITIS ACCORDING TO THE NEW ACR/EULAR REMISSION CRITERIA IN DAILY PRACTICE BASED ON THE IORRA COHORT

MORE CORTICOSTEROIDS AND LESS BIOTHERAPY IN ELDERLY RA PATIENTS : RESULTS ON A SURVEY ON 454 RA.

STEROID-SPARING EFFECT OF TOCILIZUMAB IN THE TREATMENT OF RHEUMATOID ARTHRITIS

THE USE OF GLUCOCORTICOSTEROIDS DOES NOT DISMISS THE LUMBAR BONE MINERAL DENSITY IN PATIENTS WITH RHEUMATOID ARTHRITIS, PROSPECTIVE STUDY.

EFFICACY AND SAFETY OF STEROID INJECTIONS FOR SHOULDER PAIN

EVALUATION OF A PATIENT REPORTED OUTCOME (PRO) BASED TOOL FOR THE ASSESSMENT OF SINGLE JOINT INTRAARTICULAR GLUCOCORTICOSTEROID INJECTION.

EARLY GLUCOCORTICOSTEROID RESPONSE PREDICTS THE EFFECT OF DMARDS AFTER 3 MONTHS OF THERAPY

STEROIDS AND LEFLUNOMIDE, NOT BIOLOGICS, ARE THE MAJOR RISK FACTORS FOR INFECTION FOLLOWING TOTAL JOINT ARTHROPLASTY [this is not a good thing for me if I need joint arthroplasty since this is part of my "cocktail" of drugs.]

EFFICACY OF HYDROXYCHLOROQUINE THERAPY ON WHOLE SALIVARY COMPONENTS IN PATIENTS WITH PRIMARY SJOGREN'S SYNDROME