Get your Health question answered in 3 easy steps
A Doctor will be with you shortly
Ask a Doctor Now
192 Doctors are Online

Has degeneration in her lower spine, osteoarthritis in thumbs and fingers joints. Treatment to be done?

User rating for this question
Very Good
Answered by

Rheumatologist
Practicing since : 1985
Answered : 45 Questions
Question
Hello. My wife, 53, has gradually developed osteoarthritis in her upper joints of her fingers and the basal joint of her thumbs. She only feels pain in the thumb area but not in other fingers where she has some distortion (crooked fingers). The orthopedist says her xrays and MRI indicate a relative serious case but is reluctant to go forward with surgery to remove the bone, etc. and emphasizes that her right hand would be immoblized for several weeks and full recovery would take a few months. So he prescribed twice daily Naproxen 500 mg. for flare-up conditions. Does this serve merely to postpone the inevitable of surgery or deal long-term with the inflammation that causes so much discomfort, including in the middle of the night? She took one this evening and claims so far she feels no difference.
About half a year ago she saw a rheumatologist who did not find her positive for rheumatoid arthritis in the blood tests. I am including her latest report for your opinion about all this. She has scheduled another visit with the rheumatologist next Friday to get her opinion on these developments since she saw her last.

My wife also has degeneration in her lower spine with some stenosis and some ankylosing spondylitis which only causes occasional discomfort so far.
Posted Wed, 25 Jul 2012 in Lupus
Follow-up: Has degeneration in her lower spine, osteoarthritis in thumbs and fingers joints. Treatment to be done? 3 minutes later
I just uploaded the two pages of her latest report. I forgot to do that when I sent the original message.
My wife also has degeneration in her lower spine with some stenosis and some ankylosing spondylitis which only causes occasional discomfort so far.
Follow-up: Has degeneration in her lower spine, osteoarthritis in thumbs and fingers joints. Treatment to be done? 3 minutes later
My wife is telling me that she feels some relief perhaps due to the Naproxen but wants to wait and see what happens with it by taking it for 2 or 3 weeks straight.
 
 
Answered by Dr. Praveen Jadhav 22 hours later
Dear XXXXXXX

In any case of osteoartritis, anti inflammatories should always be tried first. Many a times, inflammation subsides, gives good relief and subsequent surgery can be avoided.

However, from the report it does appear that your wife has severe osteoarthritis and that she may need surgery. But, it is still worth trying naproxen for a few weeks before embarking on surgery. Usually naproxen works fine, but sometimes, other substitutes such as ibuprofen, etodoloac, diclofenac can work better.

Dr Jadhav
Above answer was peer-reviewed by
 
Follow-up: Has degeneration in her lower spine, osteoarthritis in thumbs and fingers joints. Treatment to be done? 7 hours later
Thank you. She says the Naproxen hasn't helped much and the same has been in the past with diclofenac and ibuprofen. Why would that be the case and why would she have pain only on the basal joint especially when she already has crooked upper joints on a couple of other fingers? Why would also such anti inflammatory drugs not take care of the pain in her nervous system?
 
 
Answered by Dr. Praveen Jadhav 10 hours later
Thats the pecularity of osteoarthritis. The first carpometacarpal (basal in your words) is more painful than the distal finger joints.

It is very surprising that none of the anti inflammatory drugs are working. In that case, tramadol could be worth trying, but could be obtained only by prescription. In this case, surgery should be considered early.
Above answer was peer-reviewed by
 
Follow-up: Has degeneration in her lower spine, osteoarthritis in thumbs and fingers joints. Treatment to be done? 24 minutes later
Thank you. I was confused because I thought osteoarthritis didn't cause distortion of distal joints, and that it was rheumatoid arthritis that did.

In any event, what could be the reason that the NSAIDS are not doing what they are supposed to do? Is there possibly a psychological component in terms of feeling pain?
Presumably the NSAID would perform the work it was designed to do. Or do I misunderstand something? How would Tramadol work where Diclofenac or Naproxen doesn't? Is there anythingin my wife's report that would suggest this problem?
Follow-up: Has degeneration in her lower spine, osteoarthritis in thumbs and fingers joints. Treatment to be done? 1 minute later
Also, would there be any concern of side effects of Tramadol?
Thanks.
Follow-up: Has degeneration in her lower spine, osteoarthritis in thumbs and fingers joints. Treatment to be done? 1 minute later
Our main concern I suppose would be organ damage and addiction.......
 
 
Answered by Dr. Praveen Jadhav 30 minutes later
In fact, rheumatoid arthritis does not damage distal finger joints. Commonly it is osteoarhtritis and rarely it is psoriasis, gout, RA, etc. I am sure these conditions have been ruled out.

As mentioned, NSAID not working is a surprise. Either the inflammation is very severe or there is psychological aspect to pain. The latter is more likely as I have never seen anyone with OA (it is a relatively mild condition) who is not responding to NSAIDs. Though the distribution of joints is quite typical of OA, I am wondering if there is something else in the diagnosis.

Tramadol has a different mechanism of action than NSAID and hence worth trying. It should be used only for a short duration till a more definitive treatment is carried out. Addiction is the only worth considering side effect if used for long term.
Above answer was peer-reviewed by
 
Follow-up: Has degeneration in her lower spine, osteoarthritis in thumbs and fingers joints. Treatment to be done? 4 minutes later
I am a bit concerned about a psychological aspect to the pain issue in the diagnosis. Where should I investigate this further especially since you indicate that you have never seen anyone with OA who did not respond to an NSAID?
Do you mean that her case is relatively mild based on the report?

I suggested she try Diclofenac again but she was concerned about it interacting with Ambien to sleep, although it seems that they do not interact negatively.
 
 
Answered by Dr. Praveen Jadhav 14 hours later
It is better to try diclofenac or any other pain killer before blaming the psychological component.

Though, the imaging pictures are not mild, they are not too severe either.

Obviously, psychologist or psychiatrist is the best person to dissect the psychological component. In any case, many patients with long term pain, do develop some fear about the future and hence some resistance to treatment till their fear is allayed.

Her concern about drug interactions further reflects her anxiety. Though the literature needs to br looked into the specific interaction, you have already mentioned about the negative possibility.
Above answer was peer-reviewed by
 
Share on Facebook
Share on Twitter
Share on Google+
Question is related to

The user accepted the expert's answer

Ask an Allergist

© Ebix, Inc. All Rights Reserved.
All the information, content and live chat provided on the site is intended to be for informational purposes only, and not a substitute for professional or medical advice. You should always speak with your doctor before you follow anything that you read on this website. Any health question asked on this site will be visible to the people who browse this site. Hence, the user assumes the responsibility not to divulge any personally identifiable information in the question. Use of this site is subject to our Terms & Conditions
Already Rated.
Your rating:

Ask a Doctor