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Suggest treatment for swollen hands and feet

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Posted on Wed, 9 Dec 2015
Question: iam 41 5ftv9 about 11stone i have swollen hands and feet tmj poroblems and mid thoraic pain and neck pain take tramadol 4 times a day and started hydroxychlorine is it polyarthalgia as in lot of pain
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Answered by Dr. Matt Wachsman (37 minutes later)
Brief Answer:
I don't see a particular question

Detailed Answer:
In the diagnosis part, TMJ is a fairly straightforward diagnosis. The other issues are not. A full battery of blood tests and radiological studies are needed to assess what type of arthritis is connected to pain. There are many possibilities along the entire range of arthritis from the purely mechanical to the purely immunologic (rheumatoid and lupus for example). The immunologic are characterized by having signs of immune reactivity: swelling, pain, fever, involvement of the small joints of the hands and feet primarily involved and stiffening and swelling.

The mechanical are associated with particular joints with a particular historical reason having gradual wearing down like an eraser.

This can occur in the neck and chest and other issues such as nerves being impinged by the mechanical problems would have to be addressed.

Both are described along with the TMJ and both can occur. I cannot say in your particular case but I can give general medical information.

The treatment of particular pain issues have particular therapies for them. None of these have been mentioned. In an inflammatory condition such as rheumatoid, you'd try anti-inflammatories. Generally more than one would be tried before even trying anything else. Plaquinil is somewhat helpful in damping down an inflammatory condition but would not be the main drug used.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Matt Wachsman (10 minutes later)
Ive tried naproxen diclofenac gabapentin etc now on tramadol and hydroxchloroquine but pain is bad and swelling i have a manual job and struggling
doctor
Answered by Dr. Matt Wachsman (26 minutes later)
Brief Answer:
seveal points.

Detailed Answer:
There is still the diagnostic issue of whether there is an immunologic process involved. In which case other diseae modifying drugs might be considered such as methotrexate. This is far more toxic than the ones you are on (but not a lot more expensive) so testing would be indicated. For nerve impngement surgery can sometimes be helpful. AND in a plain inflammatory condition anti-inflammatory drugs. Although they work in the same way, anti-inflammatories of different chemical structures usually react differently in someone and as such, different types of anti-inflammatories should be tried if one class did not work. Naproxen and
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Matt Wachsman (2 minutes later)
Ok what tests would i need what other antiinfkammatories would u suggest
doctor
Answered by Dr. Matt Wachsman (7 minutes later)
Brief Answer:
sorry hit wrong button!

Detailed Answer:
Ok, in case you missed my first follow up response it was that there is still the diagnositic issue. I didn't mention what diagnostic tests these would be , in order of price
sed rate (tests if inflammation is there)
routine tests that probably won't show much (diabetes screen, electrolytes, liver tests, blood count, urinalysis)
Lupus and rheumatoid factor tests
simple x rays of neck and chest
specific lupus tests such as dna antibody
MRI of the painful areas.

The last two would generally NOT be done unless some of the earlier tests are positive. or if the physical exam showed something definitely wrong.

I don't know if you got the prevsious message. It was that although all anti-inflammatories work the same way, because they are different chemicals, individuals generally handle them .. well... individually. And, aspirin and phenylbutazone are quite different chemicals than naproxen and diflenac . So is ibuprofen but it isn't quite as strong generally as the others but could be easily tried. Steroids can work very well on a lot of inflammatory conditions including serious lupus and rheumatoid. Their use gets quite dangerous over weeks/months but only pose a mild risk of worsening diabetes or stomach irritation in the first week.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Matt Wachsman

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Suggest treatment for swollen hands and feet

Brief Answer: I don't see a particular question Detailed Answer: In the diagnosis part, TMJ is a fairly straightforward diagnosis. The other issues are not. A full battery of blood tests and radiological studies are needed to assess what type of arthritis is connected to pain. There are many possibilities along the entire range of arthritis from the purely mechanical to the purely immunologic (rheumatoid and lupus for example). The immunologic are characterized by having signs of immune reactivity: swelling, pain, fever, involvement of the small joints of the hands and feet primarily involved and stiffening and swelling. The mechanical are associated with particular joints with a particular historical reason having gradual wearing down like an eraser. This can occur in the neck and chest and other issues such as nerves being impinged by the mechanical problems would have to be addressed. Both are described along with the TMJ and both can occur. I cannot say in your particular case but I can give general medical information. The treatment of particular pain issues have particular therapies for them. None of these have been mentioned. In an inflammatory condition such as rheumatoid, you'd try anti-inflammatories. Generally more than one would be tried before even trying anything else. Plaquinil is somewhat helpful in damping down an inflammatory condition but would not be the main drug used.