Joint pain- SJS vs. RA

[Sharon]

Please can someone answer this question once and for all:

What is the difference between RA and the joint pain we get with SJS? 
Is our joint pain essentially RA or in some other category of arthritis?

No doctor will give me a straight answer on this one. 

[Jasper]

Rheumatoid Arthritis is an inflammatory arthritis that causes joint erosions and deformity.

Sjogren's Arthritis is an inflammatory arthritis but it does not cause joint erosions.

The joint pain we get can be either of these two forms of arthritis or we could have Osteoarthritis.

If we have Psoriasis, we may get Psoriatic Arthritis.

In addition, the constantly ramped up immune system (and the subsequent cascade of cytokines) can cause aches and pains in a similar fashion to the aches and pains a person gets with an infection or the flu.

I tried to find some of the articles I have read concerning the various forms of arthritis, but I cannot seem to locate them. If I find them, I will post the links.

[Sharon]

Thanks Jasper,
How would I know which type of arthritis I have at the stages where erosions/deformity might not be obvious?
What is the treatment for either arthritic diagnosis?
I also heard that lack of joint lubrication in SJS may be the culprit where pain is concerened. Anything to that in your opinion?

[quietdynamics]

Sharon here is one study
Disturbance of cytokine networks in Sjögren's syndrome, Pierre Youinou author and Jacques-Olivier Pers
Arthritis Research & Therapy201113:227
DOI: 10.1186/ar3348©  BioMed Central Ltd 2011
Published: 6 July 2011
https://arthritis-research.biomedcentral.com/articles/10.1186/ar3348

"This article is part of a series on Sjögren's syndrome, edited by Thomas Dörner, which can be found online at"  http://www.arthritis-research.com/series/Sjogrens

Information on RA tests: http://www.mayoclinic.org/diseases-conditions/rheumatoid-arthritis/diagnosis-treatment/diagnosis/dxc-20197396

I have SJS and Fibro and never fully experienced the symptom/pain difference until I was on an extended trial with Prednisone.
Hip pain and wrist pain, shoulder, ankle were resolved during the trial. Then I was left with the unique Fibro pain (which requires other medication/treatment protocol). After the trial Methotrexate was begun (it is used for RA as well).
So for me it was a matter of tests, monitoring via bloodwork, and a trial, then a change in treatment protocol for Sjogrens.

[Sharon]

Thank you quietdynamics,
How long on the Prednisone and on what dosage before your SJS pain subsided?

[eye2dry]

hi Sharon.

Of course there are specific blood tests to dx RA but as you know you can have
it without positive results. My RA was dx by symptoms and the xrays of my feet,
especially my right foot. I have erosion. My wrists hurt terribly at times but no
damage is seen as of 2 years ago with the last xrays of them.

My feet  wrists and fingers get red and warm...swell. My toes are going crooked.
I had to give up shoes with ties...buckles...etc. Anything enclosing my foot
is painful to wear/get on. I wear mostly flip flops and CROCS.....backless flat shoes.
I walk with a gimpy gait......go down steps one at a time...like a toddler on bad days.

I am interested to know if anyone out there has only sjogrens and has this amount
of difficulties.

My rheumy also told me that RA destroys joint but sjogrens does not but pain is pain.
I have several friends and acquaintance that have had to have knee, hip and even
elbow replacements with RA. Osteoarthritis is caused by wear and tear and injury
to the joint.

shelly

[Sharon]

Thanks Shelly,
My pain is relatively recent so I don't think I'd have advanced symptoms such as swelling at this point. My bloodwork is negative for RA and the xrays were "inconclusive".
However the pain is consistent with all I've read on RA and has been getting worse.
What meds help you with your RA?

[quietdynamics]

Joint Pain and Sjögren's Syndrome
Alan N. Baer, MD, FACP
Associate Professor of Medicine
Division of Rheumatology
Johns Hopkins University School of Medicine
Director, Jerome Greene Sjogren's Syndrome Clinic


-Inflammatory arthritis can lead to permanent joint damage and degenerative joint processes can trigger inflammation.
The term "arthralgia" refers to joint pain, irrespective of its cause. Importantly, patients may have joint pain, but lack signs of arthritis when examined by a physician. As will be described below, this is often true for primary SS patients.

-Joint pain is one of the most common symptoms of SS. Multiple joints are painful, usually episodically
with periods of joint pain, known as "flares", followed by periods of little or no joint pain. Arthritis
and/or arthralgia may develop before the onset of dryness of the eyes and/or mouth in SS patients and
thus be the first manifestation of Sjögren's syndrome. The arthritis of SS is often associated with other
features of SS not related to the salivary or tear glands, such as blood vessel inflammation (vasculitis),
nerve damage (neuropathy), Raynaud's phenomenon, and kidney disease.

-The arthritis of primary SS is mildly inflammatory and a manifestation of the systemic autoimmune
disease. The mechanisms responsible for this arthritis may include systemic factors which affect the
joint tissue secondarily, such as immune complexes (which can induce inflammation in small vessels) or
inflammatory mediators (such as cytokines, which induce physiologic changes in various tissues).
Alternatively, the immune reaction may be directed specifically at a structural component of the joint,
thereby inciting an inflammatory response.
The joint manifestations of Sjögren's syndrome are listed in the Table. An inflammatory arthritis,
defined by the presence of joint tenderness and swelling, usually affects many joints, particularly those
of the fingers, the wrists and the ankles. The shoulders, hips and knees may also be painful. The arthritis
usually "comes and goes" and affects the same joints in the right and left limbs in a "symmetric" fashion.
Joint x-rays are usually normal.
-

https://www.hopkinssjogrens.org/wp-content/uploads/2009/11/Joint-pain-in-SS.pdf         8pages

[Maria3667]

Hi Sharon,

Much to my dismay I found out last Friday I have ostheoarthritis. It showed up on a foot scan. I was under the impression my pain was caused by a hallux valgus (foot bump) but I was wrong. As I'm opposed to Embrell or methotrexate I searched for an alternative. The claim that glucosamine sulfate might abate the pain seems to hold true for me. Last couple of nights hip, knee and foot pain did not wake me up.

Good luck, hope you find relief soon 😊

[SjoDry]

eye2dry,

I have some of the same pain and changes that you have. My Podiatrist said that the changes in my feet and toes are consistent with RA. I have also had changes in my fingers (both toes & fingers)
leaning/crooked. I have a great deal of pain. I have a hard time wearing any other shoes that will not accommodate my inserts & even then, I still have a lot of pain.

SjoDry

[Sharon]

quietdynamics- Thank you, that was very helpful!

Maria- the glucosamine sulfate sounds interesting..what brand did you get?

[Maria3667]

Hi Sharon,

The cheapest I could get: whole jar for only 3,99 Euro 

[Sharon]

So glad it's working for you!
What dosage do you take?

[SjoGirl]

Here is a link to info about RA: http://www.arthritis.org/about-arthritis/types/rheumatoid-arthritis/

and Sjogrens http://www.arthritis.org/about-arthritis/types/sjogrens-syndrome/

from the Arthritis Foundation.

Between blood work and looking at my xrays and MRIs my rheumatologist has been able to tell me that my joint issues are actually due to osteoarthritis versus Sjogrens or RA. I don't know how he knows, but will ask when I next see  him.

[quietdynamics]

Thank you quietdynamics,
How long on the Prednisone and on what dosage before your SJS pain subsided?

The prednisone was a trial when I first went to a Sjogrens Clinic ( where I am being treated).
Plaquinel alone was not enough to manage the disease/inflammation state so Methotrexate was added.
Methotrexate is also used for RA.
Fibromyalsia is treated with other medication combo.