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Suggest Treatment For Pain And Stiffness In Knuckles
Question: For the last three months, I have pain and stiffness in knuckles of hands and feet every morning. Sometimes it wakes me up at night. It effects both left and right that lasts about an hour after I get up. No swelling, no redness, negative blood work for inflammation, negative x-ray for osteoarthritis. Dr. wants to wait another two months before MRI. I am anxious to either diagnose or rule out rheumatoid arthritis because I understand that new drugs are most effective if administered within the first two months of symptoms. Why should I wait? What else could it be?
Brief Answer:
Early Rheumatoid ARthritis
Detailed Answer:
Good evening
Thank you for writing on health care magic
Well, yes you are right. When attacking the disease in it s early stage, it has the best outcomes as there is no damage to the joints and it can go in remission quickly.
From the history you have mentioned, it very much looks like inflammatory arthritis but as you said there is no swelling/redness and the blood work up has been negative( I believe Rheumatoid Factor, Anti CCP have been done), maybe that is the reason the doctors are still in Dilemma.
1. If MRI is a costly affair and they want to wait, I would suggest you get a musculoskeltal ultrasound along with power doppler done for the hand and the foot joints. IT is less expensive, less time consuming and if the arthritis is going on it will pick up the signals early. You may not need an MRI for it then. With ultrasound findings and your history it is enough to start treatment.
2. Considering it is a seronegative variant( Rheumatoid factor, Anti CCP negative), it is always advisable to look at other causes which include ANA, ENA profile. Also just do a self examination and look for any lymph node swellings anywhere along with routine breast examination. In the negative variant always look at the secondary causes
3. Do check with your Vitamin D Levels as well as their deficiency can cause the joint pains and fatigue
I hope the information was useful
Do let me know for more queries. WOuld be happy to help out
Regards
Dr Naval
Early Rheumatoid ARthritis
Detailed Answer:
Good evening
Thank you for writing on health care magic
Well, yes you are right. When attacking the disease in it s early stage, it has the best outcomes as there is no damage to the joints and it can go in remission quickly.
From the history you have mentioned, it very much looks like inflammatory arthritis but as you said there is no swelling/redness and the blood work up has been negative( I believe Rheumatoid Factor, Anti CCP have been done), maybe that is the reason the doctors are still in Dilemma.
1. If MRI is a costly affair and they want to wait, I would suggest you get a musculoskeltal ultrasound along with power doppler done for the hand and the foot joints. IT is less expensive, less time consuming and if the arthritis is going on it will pick up the signals early. You may not need an MRI for it then. With ultrasound findings and your history it is enough to start treatment.
2. Considering it is a seronegative variant( Rheumatoid factor, Anti CCP negative), it is always advisable to look at other causes which include ANA, ENA profile. Also just do a self examination and look for any lymph node swellings anywhere along with routine breast examination. In the negative variant always look at the secondary causes
3. Do check with your Vitamin D Levels as well as their deficiency can cause the joint pains and fatigue
I hope the information was useful
Do let me know for more queries. WOuld be happy to help out
Regards
Dr Naval
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you for your very complete response. Upon my insistence, Dr. has written Rx for MRI. He wasn't confident in ultrasound alternative. Should it be a contrast enhanced MRI? Since I am paying out of pocket, I don't want to have a regular MRI that is inconclusive, then have to come back for a second more detailed MRI. But I couldn't really figure out from my research if this is necessary for my case.
Brief Answer:
MRI For Rheumatoid Arthritis
Detailed Answer:
Good evening
Well, if you have to get an MRI done let it be contrast as Gadolium contrast picks up the signals from the synovium much better than the normal MRI. And it is an expensive modality. So might as well get it done it in one shot
To tell you the fact, we have never done an MRI for any patient to diagnose Rheumatoid Arthritis. Certain facts which I will quote you from the routine practise...
1. If there is only pain and no swelling, you can give a trial of Anti inflammatory for a short duration to see if the improvement comes. If it is happening, it is definately due to Inflammation. If not we need to think of other cause. You can try with Celecoxib for a short while
2. When the diagnosis is dilemma, we prefer Ultrasound as it picks up the signals equally well, but yes it is user dependent and if the person is experienced he can pick it up
3. If there is no swelling, you can wait and watch as only swelling for prolonged duration can cause joint deformities. So you need not worry about the joints get deformed at this stage
I guess the best option would be the first for you as you still have 2 months to wait for MRI and they dont trust ultrasound.
HOpe the information was useful
Do let me know for more queries
Regards
Dr Naval
MRI For Rheumatoid Arthritis
Detailed Answer:
Good evening
Well, if you have to get an MRI done let it be contrast as Gadolium contrast picks up the signals from the synovium much better than the normal MRI. And it is an expensive modality. So might as well get it done it in one shot
To tell you the fact, we have never done an MRI for any patient to diagnose Rheumatoid Arthritis. Certain facts which I will quote you from the routine practise...
1. If there is only pain and no swelling, you can give a trial of Anti inflammatory for a short duration to see if the improvement comes. If it is happening, it is definately due to Inflammation. If not we need to think of other cause. You can try with Celecoxib for a short while
2. When the diagnosis is dilemma, we prefer Ultrasound as it picks up the signals equally well, but yes it is user dependent and if the person is experienced he can pick it up
3. If there is no swelling, you can wait and watch as only swelling for prolonged duration can cause joint deformities. So you need not worry about the joints get deformed at this stage
I guess the best option would be the first for you as you still have 2 months to wait for MRI and they dont trust ultrasound.
HOpe the information was useful
Do let me know for more queries
Regards
Dr Naval
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Above answer was peer-reviewed by :
Dr. Neel Kudchadkar
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