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Have osteoarthritis, painful joints of fingers and thumbs, X-ray shows serious case, prescribed Naproxen. Does this serve to delay surgery?

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Orthopaedic Surgeon
Practicing since : 2000
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Hello. My wife, 53, has begun suffering osteoarthritis in her upper joints of her fingers and the basal joint of her thumbs, which have become increasingly painful. The orthopedist says her xrays 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? Is a product like Naproxen cumulative or does it work as it is taken? She took one this evening and claims so far she feels no difference.
Posted Sun, 22 Jul 2012 in Bones, Muscles and Joints
 
 
Answered by Dr. Atul Wankhede 2 hours later
Dear guest,
Thanks for using XXXXXXX as your health platform.

Thanks for posting your wifes report, it was most helpful. She seems to be suffering with some severe form of arthritis which I suspect to be Rheumatoid in nature. The features like radial subluxation, erosion are characteristic of Rheumatoid. Maybe we need to investigate her in that direction as well.

Your orthopaedician is right about the conservative approach. She needs to have prolonged immobilisation with splints. The medications need to be revised though. If she's not responding to naproxen, then an adjuvant should be added. If she tests positive for rheumatoid (even if she doesn't in which she'll be labelled sero negative RA) she'll require Disease Modifying Anti Rheumatoid Drugs or DMARDS along with her NSAIDS. Naproxen is not cumulative, it works for some time after its taken.

There are surgeries to correct the deformity which are reserved as last resort. To remove the bone sounds a little harsh and is not required in this condition.

In my opinion, she still needs to be diagnosed correctly for the type of arthritis, and then treated accordingly. Feel free to ask more, I'm available for follow up.
Regards.
Above answer was peer-reviewed by
 
Follow-up: Have osteoarthritis, painful joints of fingers and thumbs, X-ray shows serious case, prescribed Naproxen. Does this serve to delay surgery? 1 hour later
Thank you. I am a little confused because she is negative for rheumatoid though has osteoarthritis. The deterioration increased in the past year. So is this additional medication used for osteoarthritis too? And why would the doctor not suggest it to her? Why would naproxen not do the job if it is anti inflammatory??
 
 
Answered by Dr. Atul Wankhede 59 minutes later
Dear user,
Thanks for replying back.

Almost 70 % rheumatoid patients test negative for serum rheumatoid arthritis factor. Many of them test positive in subsequently repeated tests. So one needs to be more certain of clinical and radiological signs than blood tests. Your doctor might not have suspected this due to a probable less incidence in the region.

Nevertheless, she can be put on DMARD's along with NSAID's empirically (like we do in sero negative arthritis) and observed for improvements. Naproxen afterall is just an NSAID and the response to any drug can be variable. She can be given an even stronger molecule but with added disadvantages.

I hope this answers your query. For any further assistance please write back to us.
Regards.
Above answer was peer-reviewed by
 
Follow-up: Have osteoarthritis, painful joints of fingers and thumbs, X-ray shows serious case, prescribed Naproxen. Does this serve to delay surgery? 3 hours later
What leads you to suspect rheumatoid from her report? What should she request from either the orthopedist or rheumatologist who tested her for the rheumatoid factor and found her negative?
Another blood test? This
may be useless if 70% are anyway negative. Should she request the DRAM anyway?
 
 
Answered by Dr. Atul Wankhede 19 minutes later
Dear user,
Thanks for writing back.

As I mentioned previously, erosions and subluxations are usually not seen early in OA, neither is affinity towards small joints. Besides she is not responding to NSAIDs.

Ask the orthopaedician or rheumatologist to reinvestigate in lines of autoimmune disease till we get the evidence of presence or absence of RA.

As I said, most of the people in those 70 % are later tested positive in subsequent tests. So she has a chance of knowing for sure in later tests. I am not sure what you mean by DRAM, can you please specify.

Thanks once again and shall await your further response.
Regards.
Above answer was peer-reviewed by
 
Follow-up: Have osteoarthritis, painful joints of fingers and thumbs, X-ray shows serious case, prescribed Naproxen. Does this serve to delay surgery? 20 minutes later
Sorry, I meant DMARD.
And do you mean she has bee.been developing both rheumatoid and osteo arthritis simultaneously in her fingers? What could be other symptoms of rheumatoid? I thought the two forms had different symptoms. She doesn't have swollen nuckles.
Follow-up: Have osteoarthritis, painful joints of fingers and thumbs, X-ray shows serious case, prescribed Naproxen. Does this serve to delay surgery? 3 minutes later
Would she take NSAID and DMARD together or just the latter?
Follow-up: Have osteoarthritis, painful joints of fingers and thumbs, X-ray shows serious case, prescribed Naproxen. Does this serve to delay surgery? 49 minutes later
I forgot to mention that my wife did visit a rheumatologist six months ago who did some further blood tests that were still negative for rheumatoid arthritis. She can go back to her again. She will continue with Naproxen but the first tablet had no effect.
 
 
Answered by Dr. Atul Wankhede 4 hours later
Hello once again.
Thanks for writing back.

Rheumatoid arthritis is a type of autoimmune disease, that can be proved to be present in a person by certain tests. Whereas osteoarthritis is an age related wear and tear disease. She cannot have two types of arthritis active in same joint.

The main symptoms of RA are multiple joint pains, small joints predilection, jont deformities, morning stiffness and many more. You can refer to our section on this website and few other sites for more details.

She'll be required to take both DMARDs and NSAIDs together.

She can visit her physician again and ask for other more definitive tests this time like ESR, CRP, HLA B27, XXXXXXX anti CCP etc.

I hope this answers your query. You are welcome to ask more if you have any confusion.
Regards.
Above answer was peer-reviewed by
 
Follow-up: Have osteoarthritis, painful joints of fingers and thumbs, X-ray shows serious case, prescribed Naproxen. Does this serve to delay surgery? 17 minutes later
So her crooked fingers are not from osteoarthritis at all on the top two finger joints?
Follow-up: Have osteoarthritis, painful joints of fingers and thumbs, X-ray shows serious case, prescribed Naproxen. Does this serve to delay surgery? 28 minutes later
There is something wrong with the website because my last message did not go through twice. I was saying that we thought her problems were related to working for 20 years as a hair stylist with repetitive movements rather than an issue of age, but of course there are other people in that profession who do not develop wear and tear of joints. The only place she has pain is on the basal area of the thumb despite some slight swelling higher up. Even the crooked finger doesn't cause any pain. She will see the rheumatologist next Friday so I can let you know what we discussed.
 
 
Answered by Dr. Atul Wankhede 8 minutes later
Hi,
Good to have you back.

Calling them crooked would be rude. We can call them deformed and in my opinion they seem more rheumatoid than regular OA. At 53, people usually don't get these deformities by age related wear and tear.

But that's just me and my opinion. We need to confirm it before we jump to conclusions.

Thanks for choosing XXXXXXX
Regards.
Above answer was peer-reviewed by
 
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