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Medical Forum / Diseases and Disorders / Arthritis / January 2005Swollen Finger Mystery
I injured my right hand ring finger a little over a year ago because I carried a heavy load too long. I started to notice that one of my fingers was very stiff and painful in the mornings. Typically it got better as the day went on and I exercised it. There was no swelling and I had full range of motion. About a month later my finger swelled up due to inflammation. I was referred to a rheumatologist who diagnosed it as psoriatic arthritis. I have significant problems with psoriasis on my skin so that supported the diagnosis. I was put on naproxen for several weeks. No effect. I was then put on methotrexate. No effect. The rheumatologist then referred me to a hand surgeon. He disagreed with the diagnosis and seemed to think I had a pulley rupture although he also noted that didn't explain why the finger was so stiff. At the time I saw him the finger was still "swollen" but he seemed to think it was due to scar tissue (versus inflammation). Anyway I was taken off medication. My finger remained contracted from scar tissue and I tried to "remodel" or "lengthen" the scar tissue by placing a gentle straightening force with my other hand. I was always gentle. However the exercise sometimes gave me a little bit of soreness in the finger which would make sense. What doesn't make sense is that my middle finger on the same hand (which did not have any external force applied to it) swelled up and has resisted all attempts to reduce the swelling (naproxen, Coban wraps, ultrasound). My question is, does anyone know of any condition or mechanism that would cause my index finger to be inflamed by working my ring finger as I described. It has been suggested that I may have an undifferentiated mixed connective tissue disease or reflex sympathetic dystrophy but nobody really knows. Has anyone ever seen something similar? I think that you should go back to the rheumatologist for a full work-up again. A hand surgeon is not qualified to make a diagnosis about whether or not you have PA. While you may have the condition that the hand surgeon believed you had, that does not preclude you from also having PA or some other auto-immune condition. The drugs you mentioned do not work in the short term but rather may require weeks or months to effect a change. In addition to that, methotrexate (mtx) is typically started at a low dose that is then increased over time. Doses of 25-30 mgs are not unusual with PA (Dr.doc, 2005) In the meantime, educate youself about PA. Here is a good place to start: http://www.arthritis.co.za/psoriasis.html Rose @}>->-- Being educated means that rather than fearing the unknown, one seeks to understand it. RB Please remove "Ima" to reply. I have been seeing doctors at a hospital at one of the top universities in the country, Stanford. Quite honestly they haven't instilled a lot of confidence in me. > I think that you should go back to the rheumatologist for a full > work-up again. A hand surgeon is not qualified to make a diagnosis [quoted text clipped - 16 lines] > > Please remove "Ima" to reply. >I have been seeing doctors at a hospital at one of the top universities > in the country, Stanford. Quite honestly they haven't instilled a lot > of confidence in me. Well, the doctors at Standord are some of the best in some ways. Doesn't mean they are good at telling you what you need to know, etc. But you can at least be assured of their medical skill. Jo \> >> I think that you should go back to the rheumatologist for a full >> work-up again. A hand surgeon is not qualified to make a diagnosis [quoted text clipped - 17 lines] >> >> Please remove "Ima" to reply. I was diagnosed with PA over 10 years ago. As of yet, I have not had the psorasis or nail pitting either. It's baffled both the rheumys I've had thus far. I'm working on a similar mystery but it is still unsolved. I have had several "sausage digits" over the last ten or so years. They are typical of PA and for quite a while my RD was convinced I had PA since I'm RA negative and don't fit the other criteria as neatly as I might. But my nails and skin remain just fine. Also fit a lot of the AS criteria but not getting worse over time either. So I've been wearing a seronegative RA diagnosis mostly to give the insurance companies something to chew on. My hands had become very stiff and swollen at the point I went on MTX. And at 15mg a week it works pretty well for me. I can't take any NSAIDS, have taken too much prednisone already in my life so only take it occasionally and can't tolerate most pain meds. I try to thank God every day my symptoms aren't worse. Sorry to be long winded, but mystery work requires detail. Sometime in mid September my left index finger stiffened and got very inflamed. I may or may not have injured it. I remember injuring my left hand the day I quit painting my bedroom trim and the day I learned my brother died. But I've had these before, though usually a toe. Did research and its typical of PA and not much to be done for it. Saw my RD in early November and she put me on a two month course of prednisone. It didn't help and by early December I was reacting badly to the prednisone or at least going into a nasty depression so saw my GP. He agreed with the RD on the finger, set up schedule to get me off the prednisone quicker and bumped up my Paxil dose. Yesterday I got in to see the hand orthopedic guy I like hoping for some sort of relief. Finger isn't getting any better and I know he is a little more willing to try things like maybe an injection just in case it might work. After he covers all the bases first. So we did the interview thing, he looked and my hand and took x-rays. They show it is not PA and that there is no arthritic type damage to the finger. Joint spaces are normal, etc. He said if it were PA there would by changes on the x-ray by now. So all the stiffness and swelling is inflammation, and there is indication of cyst formation at the second joint. He sent me to the lab to rule out gout and get a SED rate and I'm going back to see him Monday afternoon. If it isn't gout they he will inject the area. I'll post results Monday afternoon. Jo >I injured my right hand ring finger a little over a year ago because I > carried a heavy load too long. I started to notice that one of my [quoted text clipped - 27 lines] > sympathetic dystrophy but nobody really knows. Has anyone ever seen > something similar? > What doesn't make sense is that my middle finger on the same hand > (which did not have any external force applied to it) swelled up and [quoted text clipped - 5 lines] > sympathetic dystrophy but nobody really knows. Has anyone ever seen > something similar? I wholeheartedly agree with the advice to return to a rheumatologist. A hand surgeon isn't the best person to make the assessment about your PA. Even if he *is* a good doctor from Stanford. My PA began with an injury to the second toe on my right foot, and then moved to other toe joints, first on the same foot then on the left foot, and then progressed to other parts of my body. In talking with other people with PA, this seems quite a common pattern, so if your initial inflammation began with an injury and you are now seeing inflammation in nearby joints, it seems *very* prudent to me to go talk to a rheumatologist again and potentially start treatment with DMARDs (disease-modifying anti-rheumatic drugs). I speak as someone whose doctors didn't diagnose me properly in the beginning and as a result of taking too long to get the PA under control(only about a year, but nonetheless, mine is an aggressive PA), I already have significant permanent damage in some joints -- including having had two finger joint replacements. It's nothing to fool around with; keep talking to doctors until you get this under control, and don't let the hand surgeon dismiss the PA diagnosis so easily. Tracy The first person my primary care physician sent me to was the rheumatologist. He gave me the diagnosis of PA and eventually put me on methrotrexate (15 mg) for a few months. My finger never responded and the blood tests started to show I was developing inflammation of the liver that would leave to xerosis so he immediately took me off it. After the hand surgeon came up with his diagnosis, the rheumatologist reversed his diagnosis. So I am not confident that anybody really knows what it is. Some people have mentioned getting on the new biologics, but I believe the disease would have to be more extensive before they would justify using them and I'm not sure if insurance would cover them since they are extremely expensive. > > What doesn't make sense is that my middle finger on the same hand > > (which did not have any external force applied to it) swelled up and [quoted text clipped - 28 lines] > > Tracy I forget, has anyone tried injecting the fingers in question? That would probably help the swelling go down and make it easier to determine what else is going on. You'd probably need to fail more medications before your insurance will cover any biologics. Most companies want to know for certain that less expensive combos won't work for you before they approve it. At the very least, I think I'd be asking both doctors a lot of specific questions about WHY they think it is or isn't one or the other.  SignatureNann remove the Gator cheer to email me Simply the thing I am shall make me live --- William Shakespeare > The first person my primary care physician sent me to was the > rheumatologist. He gave me the diagnosis of PA and eventually put me [quoted text clipped - 4 lines] > rheumatologist reversed his diagnosis. So I am not confident that > anybody really knows what it is. Possibly not, but the fact that your finger never responded to the methotrexate doesn't mean you don't have PA. Some of my joints responded to MTX, but not all of them -- fingers included -- did, which is why I've tried three other DMARDs since. > Some people have mentioned getting > on the new biologics, but I believe the disease would have to be more > extensive before they would justify using them and I'm not sure if > insurance would cover them since they are extremely expensive. Most insurance will cover it now, especially if you've tried and "failed" methotrexate. As for the disease being more extensive -- it may get more extensive if you leave it. I'm not saying this to say you *do* have PA or to scare you, just to say that it's *really* important to stay on this until you know for sure what's up, and that *my* personal experience has shown me that the disease is unpredictable and doesn't always follow set patterns, so it may be hard to make any strong conclusions about whether or not you *do* have PA from the evidence of the finger not responding to MTX and so on. Tracy Jo, I hope your gout problem is doing better. thinking of you SignatureLove and hugs to all Good thoughts coming your way too. Squirrely Jo OK. Saw the hand ortho guy again yesterday. All my blood work is normal or near normal. Except uric acid which it at the very edge of high normal. Psoriases is ruled out as there would be damage evident on the xray by now. High normal makes gout possible although not guaranteed. I'll be taking INDOMETHACIn for a week. to see if it helps. I recognized it as something y'all take for gout when the doc mentioned it but didn't know it was a nsaid till I picked it up from the pharmacy. And I think it's helping which is both good news and bad news. Cause I know I can't take any NSAID's for any length of time. stomach and blood pressure and fluid retention. Another thing I do not like about my gout research are the warnings against dieting, particularly low card dieting. We will see how it goes, and I see him again next Monday. Jo >I injured my right hand ring finger a little over a year ago because I > carried a heavy load too long. I started to notice that one of my [quoted text clipped - 27 lines] > sympathetic dystrophy but nobody really knows. Has anyone ever seen > something similar? Jo, I have gout too. I'm the very rare pre-menopausal female with gout. There is something you may need to know about what type you MAY have. Are you an: Underexpressor (Blood uric acid levels stay high and don't express/filter through your urine) Overexpressor (Urine uric acid levels stay high due to overexpression of uric acid) I am an overexpressor. My 24 hour urines are so acidic they can melt pavement! I was plagued with kidney stones and kidney damage due to build up uric acid crystals. I have to be seen by an urologist and RD. Far as diet is concerned, some folks are stoic believers that diet will help...and it does help, but not cure! But if you are a pre-menopausal woman...talk to your doc. I have a genetic defect that cause overproduction of uric acid in my blood. Does anyone in your family have gout...esp while young (before 40's)? BUT!!! If I eat red meat a few days in a row I will have an attack that hits my toes... I can eat occasional red meat. I take one pill a day of Allopurinol and since I have been on that Rx I have not had a single kidney stone or more kidney damage. Over doing it with the Beef Brisket will still get you though! (I know, I did it last memorial day...gorged myself on brisket...cried like a baby for a week afterward!) Also....I doubt you will be allowed to do low-carb anything. Doing Atkin's landed me in the hospital with a 10mm kidney stone, and a nice little joint attack. I was on Atkins for 2 weeks. I was warned to NOT attempt that again....unless I like gout attacks. Janet R | OK. Saw the hand ortho guy again yesterday. All my blood work is normal or | near normal. Except uric acid which it at the very edge of high normal. [quoted text clipped - 46 lines] | > sympathetic dystrophy but nobody really knows. Has anyone ever seen | > something similar? First we have to determine if it really is gout. The uric acid level was not all that high and may just have been from South Beech and temporary. I have had kidney stones, they haven't been frequent and have been calcium. Lots of things to figure out. Jo > Jo, > I have gout too. I'm the very rare pre-menopausal female with gout. [quoted text clipped - 109 lines] > seen > | > something similar? I never realized gout is so complicated! Out of curiousity, is red emat the only kind that leads to flare ups? So that, say, turkey and chicken would be fine? Not that I plan on getting gout, but I'm thinking a lower carb diet might be possible if other forms of protein were used. And right now I'm hitting the soy protein powder for breakfast - no carbs and loads of soy protein though the fruit smoothies I mix it in have lots of carbs..... SignatureNann remove the Gator cheer to email me Simply the thing I am shall make me live --- William Shakespeare > Jo, > I have gout too. I'm the very rare pre-menopausal female with gout. [quoted text clipped - 32 lines] > > Janet R Any meat can be broken down to purines...which turn into uric acid. (short explanation) Red meat has the highest content. Some vegetables have purines too. Most underexpressors have to limit themselves to low-purine foods and very occasional red meat. As an overexpressor....I am allowed a slightly higher purine content. Fortunately I'm not usually a big meat eater and I don't like most other high-purine foods. If someone has gout...and gets a kidney stone...they must DEMAND a cat scan of that stone. The build up of uric acid can combine with calcium and only the calcium portion of the stone will appear on x-ray. My 4mm stone was actually a 10mm stone when cat scanned. It important to know the actually size of the stone. My father and uncle both have gout. My uncle only eats fish...no chicken or red meat...period. He suffers terribly with it...he is nearly crippled these days (he lives in NFLD....and healthcare is sketchy). My father limits red meat...works hard...drinks lots of water and takes care of himself. He is doing far better with only occasional attacks. I guess we are all different. Janet R |I never realized gout is so complicated! Out of curiousity, is red emat the | only kind that leads to flare ups? So that, say, turkey and chicken would be [quoted text clipped - 39 lines] | > | > Janet R > Any meat can be broken down to purines...which turn into uric acid. > (short explanation) Red meat has the highest content. Some [quoted text clipped - 18 lines] > > Janet R I was going to question the only eats fish till I saw where he lives. We're likely even related somewhat. I just spent a hour reading a 1904 Free Press http://www.rootsweb.com/~cannf/freepress1904.htm (A Manuel from New Bay, or at least Daddy was) Jo Related to any Campbells? Cousin Janet R | > Any meat can be broken down to purines...which turn into uric acid. | > (short explanation) Red meat has the highest content. Some [quoted text clipped - 28 lines] | | Jo > Related to any Campbells? > > Cousin Janet R Not that I know of but we have been in Nflnd since 1770 or so and with the way they intermarry up there are likely related to everyone. Related to lots of Moors and Moore Parsons Noseworthy and many others. Jo > | > Any meat can be broken down to purines...which turn into uric > acid. [quoted text clipped - 33 lines] > | > | Jo > Not that I know of but we have been in Nflnd since 1770 or so and > with the way they intermarry up there are likely related to everyone. Apparently some of them moved south and founded Arkansas. Actually....a true fact....they became Cajuns. Lucky me...Newfie dad and Cajun mom. Oh I Wonder Woman :( | > Not that I know of but we have been in Nflnd since 1770 or so and | > with the way they intermarry up there are likely related to everyone. | | Apparently some of them moved south and founded Arkansas. hunh. learn something new every day. very interesting. SignatureNann remove the Gator cheer to email me Simply the thing I am shall make me live --- William Shakespeare > Any meat can be broken down to purines...which turn into uric acid. > (short explanation) Red meat has the highest content. Some [quoted text clipped - 18 lines] > > Janet R Nann Bell wrote and asked: > I never realized gout is so complicated! Out of curiousity, is red > emat the only kind that leads to flare ups? So that, say, turkey > and chicken would be fine? Nann, the Arthritis Foundation does not separate meats - but instead restricts "organ" foods such as sweetbread, kidneys, heart, liver, etc. etc. > Nann Bell wrote and asked: > [quoted text clipped - 5 lines] > instead restricts "organ" foods such as sweetbread, kidneys, > heart, liver, etc. etc. Guess its a good thing I didn't pick up Chicken Livers at the market. The pills the doc gave me are working but not doing my gut any good at all. So they will have to be temporary. Jo > OK. Saw the hand ortho guy again yesterday. All my blood work is normal > or near normal. Except uric acid which it at the very edge of high [quoted text clipped - 16 lines] > > Jo Well I've seen how it goes. Darn it all. The indomethacin has been helping. The finger is still stiff and swollen but the soreness was going away rapidly. I wasn't feeling great. Headache since I started taking it, heartburn, IBS acting up, but had hoped we were on the right track with the finger anyway. This morning I woke up with some vague itching. Crossed by fingers and said no. Ate so I could take the med, took it and now I'm itching all over. Not a lot, no need to storm the ER but enough that I know better than to take any more. Just hope that was enough for "diagnostic" purposes. Think I'm going to take a shot of Benedryl, let Charlie know whats going on, and go back to bed. Jo ((((((Jo)))))) I hope the doctors work out something else you can take. It sucks to be feeling better then have the med that's doing it taken away. SignatureNann remove the Gator cheer to email me Simply the thing I am shall make me live --- William Shakespeare MRS. JO FIREY--now you listen to me--you will stop developing new symptoms, new allergies and new achy places this very instant. That is an order. We have firm rules about such things and you are WAAAAAYYYYY over your limit on diseases and such things. I simply will not tolerate such blatant disregard for the doctrines set down long ages past by those who must be obeyed. Personally, I think it because you have developed some strange need to be adored by doctors, nurses, med. assts, lab techs, x-ray techs and such. Their adoration is making your head spin and that is REALLY what is causing all these issues. Now just quit it--I will not have any more of this. (Here is some chocolate covered potato chips--keep them or share them with your adoring fans in the labs, x-ray rooms, doctor's offices and other such places.) Now please get your body to come to order this minute or I will be forced to take dire action and turn you in to the *Too Many Diseases and such Police*. Love Alix > MRS. JO FIREY--now you listen to me--you will stop developing new > symptoms, new allergies and new achy places this very instant. That is an [quoted text clipped - 10 lines] > to order this minute or I will be forced to take dire action and turn you > in to the *Too Many Diseases and such Police*. Love Alix Mmmmm. Love chocolate. Love potato chips. Really tired of my collection of medics. Gotta find new friends in a different field. Jo hi, my names dominique im 19 and have waht you would call a normal student life - however this time last year maybe a bit longer than that my right index finger swelled up right on the joint. soon after my left index finger did the same. now i have been to 7 doctors (and counting) ive had xrays, blood tests ive even been to chinese herbal remedy shops - yet no one knows what this thing on my finger is - how it came about or how to cure it. after it being there for bout 3 months it slowly died down but the reminents were always obvious - until last week when it returned again - the joint is stiff to bend and quite painful just like last time but having had xrays and tets etc last time they are sure i do not have arthiritus of any kind - can any one help me? i may be being vain but at university and 19yrs old the last thing i need is what my mum refers to as "a freaky finger" which cannot be explained. many thanks You can have "pauciarticular Rheumatoid arthritis" that is localized to one joint. You could also have tendon damage which may not show up on an exray. Of the seven doctors that you have seen, have any of them been a rheumatologist? Keep persuing it. Be thankful that it is localized, so far. Rose @}>->-- Being educated means that rather than fearing the unknown, one seeks to understand it. RB Please remove "Ima" to reply. > You can have "pauciarticular Rheumatoid arthritis" that is localized > to one joint. You could also have tendon damage which may not show up [quoted text clipped - 9 lines] > > Please remove "Ima" to reply. I second what Rose has said. If you have not seen a rheumatologist, ask for a referral to one. If you have seen one, you might ask for a referral to a different one. From what you said, it doesn't sound like you got the therapies most RDs would have tried right off the bat. SignatureNann remove the Gator cheer to email me Simply the thing I am shall make me live --- William Shakespeare Hi Dominique, I'm really sorry about your finger-I don't think you're vain at all. I have the same exact thing on my left index finger and a year ago I had a similar problem with the ring fingers on both hands. I posted about my experience here recently. I am going to an ortho on Monday and a second rheumatologist in Feb. after being dismissed by the first rheumatologist. This is not normal regardless of what x-rays and blood tests show (since in early stages of the disease often nothing shows on x-rays or bloodwork) and little by little I will find a doctor who knows what's going on. Don't give up. I'm going to look up "pauciarticular RA" that Rose mentioned since I haven't heard of it before. This group is a wealth of information. Lisa > hi, my names dominique im 19 and have waht you would call a normal student > life - however this time last year maybe a bit longer than that my right [quoted text clipped - 10 lines] > "a freaky finger" which cannot be explained. > many thanks Just thought I'd apologize if I sounded uncaring. I didn't mean it to be that way. and when I said you should be thankful was thinking more in a glass half full or half empty kind of way. I meant don't worry too much about the appearance of the finger; from that point of view it is probably you who notice that much more than anyone else would. pauciarticular means localized to only a few joints. I know of one little girl who had pauciarticular RA in her toe joint. I am not sure what the outcome was as she moved away. Whether this is the case only for JRA or RA in general I do not know. Rose @}>->-- Being educated means that rather than fearing the unknown, one seeks to understand it. RB Please remove "Ima" to reply. Hi, I'm the person who started this thread. Besides going to a rheumatologist I went to a hand surgeon. They couldn't positively diagnose me but they said I might have RSD (or Reflex Sympathetic Dystrophy Syndrome). It is also known as Complex Regional Pain Syndrome (CRPS). The hand surgeons don't really know and they are referring me to a pain specialist. RSD is usually associated with pain but I am told it isn't always the case. Sometimes it can just manifest itself as a chronic inflammataion and swelling. One of the signs is increased shininess of the skin. Anyway I am pursuing all the leads I can. I just started Arava a disease modifying drug and I am going to see what the pain specialist can tell me. I have also heard of something called neurogenic inflammation, but I don't know if it is the same thing or not. You can find some info on RSD at www.rsds.org Mike > hi, my names dominique im 19 and have waht you would call a normal student > life - however this time last year maybe a bit longer than that my right [quoted text clipped - 10 lines] > "a freaky finger" which cannot be explained. > many thanks > Hi, > [quoted text clipped - 15 lines] > > www.rsds.org They mention Fibromyalgia (which I have) on the site and I didn't quite understand if they were related or the same thing or? It was interesting but a bit confusing. Mike, I hope you'll post your updates here. Lisa |
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