Preclinical RA - To treat or Not To Treat

[@mamashiraz]

I enjoyed this video but I have a lot to say. #1 Doctors need to realize that your RF and antiCCP tests are not the end all being all in making an RA diagnosis. That’s because what your calling “pre-clinical” may in fact already be moderate to advanced disease if and when the doc orders that “expensive” MRI or ultrasound. Believe it or not, there’s people walking around with active, destructive AI disorders who have negative run of the mill rheumatological blood tests. Their complaints of pain need to be taken seriously and diagnostic tests need to be done to rule out an AI disorder especially if the have a positive ANA. If tests do not show any sign of AI, then possibly take the wait and see stance but at least investigate so any damage being done is caught early. Case in point: woman has severely dry eyes and corneal damage for 10+ years. SSB/SSA came back negative so no treatment other than duct plugs was done. Symptoms get worse and the bloodwork was repeated and still came back negative except for a positive ANA. Woman goes for a second opinion. A highly educated infectious disease specialist runs a full extensive work up on patient. It’s true Ro and La was negative BUT antisalivary and anti carbonic anhydrase came back high positive. This is part of Thr Early Sjogrens Panel!! He also discovers woman has Antiphospholipid Syndrome as well. RF and anti CCP are negative but ultrasound shows moderate to advanced synovial thickening with BONE EROSIONS and diagnosis RA (“seronegative”). It’s high time doctors get educated on how AI disorders can present and stop letting insurance companies dictate what tests are necessary and allowed to be done on patients. Too many patients suffer for too long and end up going untreated that results in permanent irreversible damage.