With Rheumatoid, please don't have a High Pain Threshold

With Rheumatoid, please don't have a High Pain Threshold

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By Dr Irwin Lim, Rheumatologist

I met a new patient this week with seropositive rheumatoid arthritis. She has both the rheumatoid factor and the anti-CCP tests positive, with elevated inflammatory markers in the blood tests, and many joints inflamed.

In short, she has active, aggressive disease. The type of rheumatoid arthritis that will lead to bad outcomes if untreated.

This is the patient we would typically treat aggressively with multiple medications if needed, to control the disease as quickly as possible.

She has had disease for over 2 years. Initially, the disease seemed episodic & mild, but in truth, she ignored it due to her difficult social situation and the need to "just get on" with life.

She uses anti-inflammatory medication. She works, looks after the family, and just copes with the pain and stiffness.

The swelling of her knuckles and intermittent limp due to the swollen knee slowed her down but didn't stop her.

Until now.

Pain still isn't the issue. She's now presented for help as she's losing the ability to grip and she wakes up so stiff, it takes hours to feel like her body can move properly. And she's so tired.

We're obviously starting disease-modifying treatment and the goal is still remission but it's going to be much harder as we've probably missed the window of opportunity one has with rheumatoid arthritis.

If only she was more of a whinger. If she didn't deal with pain "so well" and complained more, she might have seen a rheumatologist much earlier. Typically the earlier we treat and control rheumatoid arthritis, the better the long-term outcomes.

With rheumatoid arthritis, it's probably not good to have a high pain threshold.

Do you know anyone like this? Please share your experience.

Dr Irwin Lim is a rheumatologist and a director of BJC Health. You should follow him on twitter here.
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