While driving, I had pain with the simple act of pressing my foot on the gas pedal. I had difficulty walking down long halls at work, something I had done hundreds of times without even thinking. I had trouble typing, which made the use of my electronic medical record difficult. My 4th and 5th fingers would not work as my brain directed. I always attempt to be gentle when shaking a patient’s hand, and now some of my patients were unknowingly causing me pain with their greetings. I had difficulty maneuvering a leg to examine a hip, and I had difficulty holding a syringe. I could not turn on the shower in the morning. I could not knit, sew or take pictures, activities that I love. When I told my husband that I was pretty sure I had rheumatoid arthritis, the first thing he said was, “Time to give away all of your yarn.” This was not what I needed to hear.
I did have risk factors for rheumatoid arthritis. I am female. I have a family history of lupus in two maternal aunts and a cousin. I had a gastrointestinal illness at the onset of my initial joint symptoms two years previously. Research suggests that alterations in the microbiome may play a role in the initiation of autoimmune disease. In one study, an increase in the bacteria Prevotella copri correlated with disease in new-onset rheumatoid arthritis.1 I also had a history of recurrent idiopathic pericarditis that may have not been idiopathic after all.
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One thing I struggled with was when to seek care. I was caught between self-doubt and the urge to act: self-doubt about the reality of my symptoms and the probability that I had an inflammatory arthritis. I did not want to be wrong in my diagnosis. The urge to act struck me on the first morning I awoke with hand stiffness. Part of me knew right away that I had to start a disease-modifying antirheumatic drug (DMARD).
For weeks, I questioned myself: Is this truly RA? Have I waited too long? Has irreversible damage occurred? Will this just go away? I tried to take a step back and look at myself from the intellectual standpoint of a physician, but it was difficult to objectively think of myself as the patient. Like my fellow rheumatologists, I have complete confidence in my ability to detect synovitis in a patient. However, I found it impossible to be objective when examining my own hands.