Anyone have a diagnosis of undifferentiated arthritis?

[Deni37]

Does anyone have a diagnosis of "undifferentiated arthritis" with symptoms of finger, hand, and wrist arthritis?  If so, what is your treatment therapy?  I was originally diagnosed with SLE in sept 2010 with main symptom of arthritis but prior skin, photosensitivity, and mouth ulcers, plus ANA of 1:640.  At that time my rheumy was thinking i had RA but i had no bloodwork indicating RA, so he thought i had SLE instead.  Over the past year my arthritis persisted despite doses of prednisone ranging from 6 - 40 mg per day and I failed on MTX so was switched to Imuran at the max dose of 150 mg per day.  That didn't do the trick so I was put on humira in mid April.  I am currently taking prednisone (5 mg per day and tapering), plaquenil, imuran, humira (every 10 days), celebrex (100 mg twice a day), elavil (low dose for insomnia and chronic pain relief), and a couple meds for GERD & Barret's esophagus too.  I've never been a pill popper before aug 2010, but I am convinced all these meds are truly needed since I now can use my hands again without major pain and stiffness (still have some but it's MUCH better than last year).  Am hoping they can figure out which type of inflammatory arthritis I have, but the bloodwork still doesn't reveal RA definitively with just the highly positive ANA but no other abnormalities (besides positive TPO antibodies that make me likely to also get hypothyroidism in the future).  Wondering if there is anyone out there with undifferentiated arthritis being treated with humira and other similar meds?  Most folks on humira seem to have RA or another definitive type of inflammatory arthritis....sure hope someone will figure out whether I have seronegative RA, SLE, or another form of inflammatory arthritis some day...it's difficult to find a support group for undifferentiated arthritis, especially the moderate to severe form I have been experiencing over the past year!

[Deni37]

Hi again...thanks to you as well for your reply & encouragement...it's been a rough year for me, but I'm doing much better than I was last Dec thru May, which I attribute largely to the Humira & Celebrex, though it may be the "synergistic" effect between all of them ...we didn't get to this combo overnight, and I don't know how long I'll be able to safely stay on all of them, BUT I do know my chronic pain & stiffness & fatigue are much lower now...and I'm looking forward to getting off the prednisone, which, as you know I'm sure, is probably the most toxic of them all...I honestly haven't had any significant side effects from anything other than the prednisone (keep in mind I was on 6 - 40 mg per day over the past year, and over 20 mg per day for over 6 months)...and I should mention that I was also diagnosed with GERD & Barrett's esophagus last Feb 2011, so we are of course being careful with meds that can aggravate GERD (Ok, I'm still on the Celebrex though I know my rheumy & GI Doctor might prefer otherwise, but I'm willing to take those risks because it has almost completely relieved the very painful metatarsalgia I was experiencing the past 3 - 6 months...when you take the Humira, you usually take it with another DMARD, such as methotrexate for most RA or SLE patients, BUT I failed MTX when I was on just prednisone & MTX last Fall 2010, so my rheumy had already switched me over to Imuran ( at the max dose) when he decided to add the Humira after we discovered that the prednisone/Imuran combo wasnt doing the trick (swelling was down but I was still having a lot of pain in my fingers, hands, and wrists plus stiffness)...we added the Humira in mid April and after it appeared to be working (about 2 months later), I started tapering down the prednisone from then 20 mg per day already down to 5 mg per day now...and haven't had any significant pain, stiffness, or swelling back thankfully...sure, I'm not entirely pain & stiffness free, and may never be, but I'm able to function effectively now and keep working a full-time, pretty demanding job in the emergency management arena, which is something that was a major struggle over the past year...because I developed persistent insomnia from the steroids, worsened by some anxiety, I was on ambien and then lunesta for a while, but they both worked poorly on me, so my rheumy put me on low dose Elavil (25mg) that helps with insomnia & chronic pain, and it's been a huge relief for me...chronic pain & fatigue are so much worse when you have chronic insomnia on top of that...and I had not slept through a single night in over a year even when I was on the ambien & lunesta!  But the Elavil has worked wonders with just some mild side effects at the low dose I'm on (dry mouth & increased hunger, both of which I can live with more than the insomnia)...so, the bottom line is, please go find a rheumatologist who will listen to your history, take time to reflect and research it, take your complaints seriously (even when there is only pain and no other physical symptoms or bloodwork to prove much), and be willing to try meds until you can find some relief....that of course must include weighing the risks & benefits of each med carefully...especially considering any other health issues you may have, pregnancy (since as you know that affects which meds you can safely take), etc...that said, we all know there's no magic cure for any of our chronic, systemic, autoimmune, connective diseases, regardless of what they call them so I'm still taking it one day and week at a time - enjoying the "good" days and making it through the "bad" days, which for me have been fewer in number lately fortunately...I wish you continued courage, determination, and perseverance...you deserve the best, so please don't forget to take care of yourself as you take wonderful care of everyone around you!  Please keep me/us posted on how it goes!!!

[trying43]

I actually had very few side effects at all from that combo of meds at all. With the humira I felt horrible, the fatigue was worse with that than just the regular fatigue I get.  I am also a mom of 3 young kids, 9, 7, and 8 months so I don't have time for this mess! Lol My "illness"began in 1997 with right hip pain.  Hopefully u can get some answers and the right meds soon.  Good luck

[mollyadelaide]

Thank you for your comment on my question too! And for your encouragement! I'm so glad your current medication mix seem to be working for you. That is at least something to be thankful for. I am like you it would be really nice to have a label to put on this but it's more important to receive treatment. I think all autoimmune diseases effect each person slightly differently. It's certainly one of the things that make them more difficult to diagnose. One of the more recent rheumies I've seen told me the trend is different now than it was years ago in that they'd rather wait to put a label on it to be sure of what it is rather than tossing the label and then withdrawing it later. (Which is what essentially happened when they called mine RA 17 years ago.) My diagnosed disease actually began with finger and hand swelling and pain. And I do get aches and pains in probably most joints from time to time. I have what they call the swan neck deformity in both of my ring fingers, but it can be moved back. Which apparently lends itself more to a dx of lupus than RA. I wonder now though if it may be RA b/c I have OA in my neck - maybe caused by the RA? And I am suspicious of the ongoing pain in my knees and hips as being OA as well - maybe from the RA? I don't know. I know that I need to be more persistent in seeking the answers and seeing the doctors. I get frustrated by the process to be honest! I don't have a lot of time I'm a mom of two young kids and one more soon to be born. So b/c of the pregnancy and prior to that nursing and being pregnant I haven't been on any meds for quite some time which I'm sure is a large part of my problem. I have been on various types of nsaids, plaquinel, prednisone, and celebrex - and a calcium channel blocker for the raynauds. I have never heard of so many drugs being used in combination before. But it makes sense for sure that they would compliment eachother. Do you find yourself with many side effects? Early on I was discouraged by a stomach ulcer and other stomach issues. Though I think I'm hurting enough now that I am willing to find some relief:)

[trying43]

Hi that's what my first diagnosis was before I was diagnosed with AS.  The humira and enbrel didn't help much except it cured my eye infections. I was on celebrex, plaquinel, flexaril, tramafol, and topamax(for my seizure disorder) and I also took a multivitamin, vitamins, and fish oil and I finally felt good and was mostly pain free.(had to stop all meds we wanted a baby so haven't started back yet because I am also nursing so everything is back with a vengeance) to me it was a frustrating diagnosis because there was no name or specific treatment.  I went to a research hospital and they finally pinpointed what I had and put me on the above meds listed.  Good luck to u.

[S. Kaul, MD]

Hi there!

Well, there is no best described treatment for undifferentiated arthritis. Usually a combination of immune suppressing agents, disease modifying agents and anti-inflammatory medications are used. Though infection has been sited as a possible cause, antibiotics do not see to work well. Without a detailed history and a clinical evaluation it would be inappropriate on my side to suggest anything. I would suggest consulting a rheumatologist, preferably at a university/ teaching hospital for appropriate management.
Hope this I helpful.

Take care!