The many faces of RA

Back in the olden days (1986), when I was first diagnosed with rheumatoid arthritis, it never occurred to my 31-year-old self that there might be other types of RA than the one I had.

And why should it? I was surprised enough to learn that I had RA at all: a disease that wasn’t caused by some outside marauder, like a virus or bacteria, but by my own autoimmune system mistaking my joints for viruses or bacteria.

All I really understood was that I’d somehow gotten a disease that I’d always associated with old people and the commercials for iron pills and creams for sore joints and muscles I’d seen as a child while watching The Lawrence Welk Show at my grandma’s house.

And, from recent experience, I knew that RA could be extremely painful. Sometimes the affected joints hurt so badly they impaired my ability to work—and everything else. A flared hand could keep me from taking notes and typing, an integral part of my job. A flared shoulder made it really hard to wash and fix my hair and get dressed. And depending on which shoulder  or foot the RA bit into, driving my stick-shift car became a huge challenge, too.

Still, I was lucky. Prior to making a final diagnosis, my doctor ordered a blood test. He was looking for a protein called the Rh factor, a clear indicator of rheumatoid arthritis. He found it. I was seropositive for RA.

My doctor explained the basics: RA strikes at any age. It can be treated, but it’s incurable. RA attacks more than the joints, too, he said. It can damage soft tissues like the heart, the lungs, the eyes and even the veins, and while remissions occur, they’re rare. I’d have RA the rest of my life.

Unfortunately, many people have RA, but don’t show the Rh factor in their blood. They’re seronegative, and it makes diagnosing the disease much more difficult. Because there are so many diseases, syndromes, conditions that can mimic RA (such as fibromyalgia, neuropathy and Lyme disease), doctors sometimes rule RA out if they don’t find the Rh factor in the patient’s blood. It can take a long time to get a diagnosis—and finally, treatment.

Doctors now believe that the earlier in the course of the disease a solid diagnosis can be made, the more likely it will be RA medications—DMARDS in both their original and biologic forms, along with NSAIDs—can slow or even arrest the disease’s progression, preventing as much joint damage and deformation as possible.

There are several other forms of rheumatoid arthritis: ankylosing spondelitis, polymyalgia rheumatica and juvenile idiopathic arthritis.  Click to learn more about them.

8 thoughts on “The many faces of RA

  1. Wren: Thanks for the thoughtful post. As you point out, there is a lot of “learning” to do about the disease and how it affects us individually. I am one of the sero-negative folks. I sometimes think it would be nice to draw a line under things with a positive R-factor saying that, YES, that’s what’s wrong. But as long as the treatments help, I am thankful.


  2. Hi Wren,

    I’m confused – I understand PR is a muscular disease so not sure it can be a type of RA – although a type of autoimmune disease, sure.

    Oh well – you’ve given me something to think about!!

    Polly x


  3. Ah the standard shift car. That was one of the first things to go after diagnosis.
    I’m seronegative but was lucky to have a very good doctor who looked past the blood work to my symptoms. Although I test positive for lupus, I presented with classic RA. Like Carla, I wish my blood work was positive for RA. After all these years I continue to test as positive for lupus and present as ra. What a strange thing the immune system is.


  4. Great post, Wren. Very informative. Sad to know you were diagnosed in your 30’s. It didn’t strike me till my late forties and I thought that was young! What an insidious little monster disease is.


  5. This is the first time I have seen polymyalgia rheumatica classified by a medic as a form of RA – but I have often told patients that PMR is like a relatively benign version of RA because severe cases are equally as incapacitating as RA but – mercifully – we don’t have the joint destruction. Mind you – try telling doctors that! A friend of mine was told this week to go and do Pilates and yoga as they were good for PMR – she can barely get out of a chair and walking really does have its moments!
    Not that it helps us a lot – the only way of managing it is pred and you know how doctors regard THAT. I can take pred or I can be immobile – but for the majority of patients their doctors tell them they have been on pred too long, it’s dangerous and they must get off it asap. Personally I can’t see the point of not taking pred in case it leads to osteoporosis but being immobile – as that also leads to osteoporosis. I know – it isn’t quite as simple as that, but you know what I mean.
    Food for thought…


  6. Pingback: Polymyalgia rheumatica: setting the record straight | RheumaBlog

  7. I don’t believe this is an accurate statement.
    “There are several other forms of rheumatoid arthritis: ankylosing spondelitis, polymyalgia rheumatica and juvenile idiopathic arthritis.”
    For example, Ankylosing spondylitis is considered a spondyloarthropathy in the same family as:
    Undifferentiated Spondyloarthropathy
    Juvenile Spondyloarthropathy
    Psoriatic Arthritis
    Reactive Arthritis
    Enteropathic Arthritis
    I believe that JIA is considered its own entity as well. It is an umbrella term used to cover several different types of juvenile arthritis.

    Now, if you want to state that there are 100s of types of arthritis or autoimmune diseases, that’s a fair statement.


  8. BTW, being diagnosed with a seronegative form of autoimmune arthritis is typically a long process. I have totally normal bloodwork but radiographic damage. Took about a year to get the diagnosis of psoriatic arthritis. The spondyloarthropathies tend to be diagnoses of exclusion.


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