After I saw 5 orthopedists in Hong Kong and nobody has ever suggested a blood test to check if I have RA or not in as long as 2 years, I really lost my faith in Doctors in HK. So I booked a medical check up in May, appointments with a podiatrist, one with a traditional and conservative rheumatologist at a big hospital, and one with an aggressive rheumatologist at his practice, all in Tokyo in June.
Since my stay in Tokyo was as short as 1 week every time, I tried to make my schedule very efficient but still doable, I mean, I cannot get too tired to show up to all of these appointments!
When I received the positive blood test, anti-CCP antibody test, 195, which is much much higher than the normal value of ‘less than 0.6’ in May, I was shocked of course! However, to tell the truth, I got relieved at the same time. Since, I had been seeking what was wrong with my thumb and feet for such a long time! Finally I came to know what it is!
Moreover, now it is rheumatoid arthritis which is the root cause of the pain and swelling on my right thumb and feet. It was not osteoarthritis on my thumb, Morton’s Neuroma on both feet, and bunionettes on both feet! Also if it was osteoarthritis, there would not be any cure. But since this is RA, I could reach remission! It seemed to me much better to get remission rather than no cure with progressive symptoms.
After a blood test and X ray, the conservative rheumatologist at a big hospital said, “It is highly likely that you suffer from RA, but we will have to double check. There are many different diseases within the group of autoimmune disorder diseases.” “When will a joint ultrasound test available, Nurse?” “July 20th, doctor.” It was on June 16th! There will be as many as 40 days until July 20th! “Oh doctor, my symptoms will be aggravated in 40 days! Could you please give me earlier date?” “I’m sorry. There is a long queue.”
So he couldn’t prescribe any RA medicines except for painkiller, Loxonine/Loxoprofen sodium hydrate, and Loxonine plasters for me, even though the speed of progression of my RA symptoms got accelerated especially on my finger joints since this April.
I know, you might not be familiar with Loxonine, since it must be Celebrex if it had been in the States or Hong Kong. Mysteriously popular, Loxonine is the most and the strongest prescribed pain killer in Japan. Actually when I took one tablet of Loxonine after breakfast one morning, I got excruciating pain from it and the pain lasted for 3-4 hours without diarrhoea thank goodness.
On the other hand, the aggressive rheumatologist gave me a blood test, X ray, MRI on my thumb, and bone density test on my foot, and prescribe me Methotrexate and folic acid already on the first visit. “It might be a little bit premature to diagnose it RA now. However, since your anti CCP antibody is high, you’d have RA definitely sooner or later” He explained that they can use Methotrexate as a means of disease prevention.
So I started taking 8 mg of Methotrexate on June 26th 2016!
Japan is known to be different from other countries in many ways. And this is one of the examples.
Methotrexate in Japan comes in 2mg tablet, whereas all the other countries, 2.5mg. Also the maximum dosage of Methotrexate has been just increased to 16mg from 8mg in Japan, while the rest of the world 25mg. Of course most Japanese people are smaller than Westerners so it makes sense to have lower dosage, but maybe not the half. This is another example of how Japan is cautious about introducing medicine to its market.
Accepting the idea of taking Methotrexate was really hard to me, since MTX is to lower your immune system. There are so many serious side effects from MTX. If I am right, RA is caused by the malfunction of our immune system in which our immune system attacks our own cells rather than external enemies. What is wrong is the direction of our immune system works, but not the strength of our immune system. So I would say what should be done to get cured from RA is to change the direction the immune system works. But it is not to lower the immune system itself.
I tried to persuade myself that this is a temporary measure to take MTX and lower my immune system to stop the inflammation, swelling, and pain for now. I will also try to correct the direction my immune system works by natural therapies, supplements, diet, exercises, or anything at the same time.