Ask the Expert: Dr. Vivian Bykerk, Rheumatologist, Answers Your Questions About Managing and Treating Rheumatoid Arthritis

by Dr. Vivian Bykerk
Dr. Vivian Bykerk, Rheumatologist

Q1. I’ve had RA for 13 years. What kind of surgery is done for elbows that seem to be separating? The distance between the joints in mine is getting farther and there is so much pain. I don’t have the nodules but there is a space about 1 ½ inches between them. It is beginning to cause me problems. Is this common? It hurts to do anything with my hands and arms.

It is possible now to do joint replacements of the elbow. Orthopedic surgeons specialized in procedures of the upper extremities will carry out this procedure when x-rays show that the joint has been completely damaged by the disease and the pain and function are intolerable. This is not common but happens in people with severe RA. If you are concerned, you should contact your rheumatologist and have x-rays done of your elbows to see what can be done to help you manage your pain and function.

Q2. Are there any RA drugs women should avoid if they want to become pregnant?

Patient should not take leflunomide (Arava) for up to two years before considering pregnancy and should not take methotrexate for weeks before conceiving a pregnancy. Other medications may need to be adjusted or stopped once you are pregnant. It is important to consult with your physician.

Q3. I just started experiencing minor joint pain in my fingers and wrists when I wake up in the morning. Is there anything I can do to slow the progression of RA?

From your question it sounds like you have RA that is not completely controlled. You should see your rheumatologist to determine if your medications need to be adjusted. There are many treatment options including DMARDs (pills) and biological therapies (injections) that are very effective at improving signs and symptoms of RA and also halting progression.

Q4. I read in a study that vitamin D inhibits inflammation. What is your recommendation on the use of vitamin D to help reduce inflammation in RA?

There are no studies that show that vitamin D inhibits specifically the inflammation of RA. There are studies that inflammatory diseases, most notably multiple sclerosis, occur more often in areas where sun exposure is lower (and hence vitamin D levels are lower). There are studies to show that vitamin D levels need to be optimized for good bone health and patients with RA more often have low bone mass thus it makes sense to ensure you are getting enough vitamin D as a supplement if your levels are low.

Q5. I’ve never used an infusion like Remicade or Actemra or an injection like Enbrel before. If I start with an infusion before trying an injection, will it be difficult to try an injection later on?

There is no problem with trying an infusion therapy first and injection therapy later on.

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The information provided in this blog by HSS and our affiliated physicians is for general informational and educational purposes, and should not be considered medical advice for any individual problem you may have. This information is not a substitute for the professional judgment of a qualified health care provider who is familiar with the unique facts about your condition and medical history. You should always consult your health care provider prior to starting any new treatment, or terminating or changing any ongoing treatment. Every post on this blog is the opinion of the author and may not reflect the official position of HSS. Please contact us if we can be helpful in answering any questions or to arrange for a visit or consult.

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