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Finger joints

  • By Dixie_Darlin

    Hello, I believe I’ve had RA for some time now but the blood work finally came back positive in May. I’ve been having the typical flares, but I’ve noticed now that in two of my fingers, middle finger on left hand, thumb on right hand,the knuckle joints are always hurting and that it’s kind of numb, with some type of knot like things. It’s not something you can see quite well, but I know it is there. My thumb knuckle doesn’t really bend as it use to and I know my knuckles are bigger/swollen than they use to be. What I’m wondering if anyone knows if this could be those RA nodules? I was so hoping I’d not get any of those. Does anyone have any photos of the nodules when they’re just beginning please? I haven’t been to a Rheumatologist yet and it looks like it will be some time before my insurance can find one for me. Thanks.

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  • By Andrew Lumpe, PhD Moderator

    Hi Dixie, Those could be a number of things including nodules, cysts, or just plain swollen joints. It would be best to speak to your doctor about what’s going on so they can accurately diagnose and treat accordingly. Hopefully you can find a good rheumatologist and soon.
    Andrew

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  • By Dixie_Darlin

    Thanks so much for your reply Dr. Andrew! Your time is greatly appreciated. While I have been waiting awhile to get a rheumatologist, I can report today they have found me one! I can hardly wait to get my first visit.

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  • By Andrew Lumpe, PhD Moderator

    That’s exciting! I hope that your first appointment goes well and you get on a treatment plan. The standard of care from the American College of Rheumatology now is to treat early and aggressively. Make sure to have a list of questions. Your first appointment should be longer than the usual 15 minute follow-up so take time to learn all you can, get a good exam, talk about lab tests, and discuss treatment options. Hang in there as sometimes it takes trying a number of treatment options to find the best combination. Keep us posted!

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  • By Dixie_Darlin

    Thanks so much and I certainly will follow-up. Never thought I’d say I can hardly wait to see a doctor (No offense) it’s just today fingers, shoulders, and feet are swollen. Otherwise, I’m well and blessed. =) Have a good evening.

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  • By Dixie_Darlin

    Follow-Up: Hi Dr. Andrew, I went to the Rhuemy and he looked over my history, not all, but most. Afterward he said he’d have to see me again to do some labs once he gets authorizations from the insurance. I took all the labs I had with me to the appt. I have an appt for January.

    You were right about my fingers, I was told it was swelling and I guess it just never goes down. I didn’t really get to ask many questions, but I can say that swelling is painful if bumped on anything. At the appointment he gave me two Kenalog shots in the behind and told me that should let us know what’s wrong. He also said he thinks most of my problems are not related to Fibro.

    Well not sure if the shot is suppose to act this way, but the second day I felt really good, then I’m back into pain (8 to 10) in my sac joints/pelvis and my spine. It seems worse than before. Very hard to walk. I noticed my nose seems to be dripping a lot as well. Could you tell me more about the Kenalog injections and what they’re suppose to do? I certainly appreciate the time you give to talk to us on this forum. I know time is money, thank you again.

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  • By Andrew Lumpe, PhD Moderator

    Hi Dixie, positive blood work or not, it is imperative to get RA treated right away to get symptoms and joint damage in check. Is there anyway to push your insurance to get you to a rheumatologist sooner? They should be familiar with the diagnostic guidelines that stress early treatment.

    In terms of relationships with doctors, it is important to find one with whom your comfortable, who carefully listens, doesn’t discount symptoms, treats to the target of getting as close to remission as possible (which may mean trying a variety of medicine combinations and doesn’t wait around to treat), and one who doesn’t over rely on blood tests which are not always indicative of disease activity. I want a doctor who when they come in the room, looks me in the eye and first asks how I’m doing and doesn’t bury their head in a computer screen. A good rheumy should be familiar with the latest research in RA. You might want to have a doctor whom you can contact via phone or email for a quick question should the need arise. I like to bring in a set of questions into appointments so I know they get answered during the short appointments.

    In terms of nodules, you can find lots of pictures online but make sure your doctor looks at your fingers. It could just be your joints are really swollen also. Nodules tend to be hard and painless.

    Hope you get into a rheumy soon and get some answers and an effective treatment plan.
    Andrew

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  • By Dixie_Darlin

    Follow-Up:

    Hi Dr. Andrew, I went to the Rhuemy and he looked over my history, not all, but most. Afterward he said he’d have to see me again to do some labs once he gets authorizations from the insurance. I took all the labs I had with me to the appt. I have an appt for January.

    You were right about my fingers, I was told it was swelling and I guess it just never goes down. I didn’t really get to ask many questions, but I can say that swelling is painful if bumped on anything. At the appointment he gave me two Kenalog shots in the behind and told me that should let us know what’s wrong. He also said he thinks most of my problems are not related to Fibro.

    Well not sure if the shot is suppose to act this way, but the second day I felt really good, then I’m back into pain (8 to 10) in my sac joints/pelvis and my spine. It seems worse than before. Very hard to walk. I noticed my nose seems to be dripping a lot as well. Could you tell me more about the Kenalog injections and what they’re suppose to do? I certainly appreciate the time you give to talk to us on this forum. I know time is money, thank you again.

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  • By Andrew Lumpe, PhD Moderator

    Kenalog is one of many artificially produced corticosteroids which are hormones that the body naturally produces. They are involved in inflammation control and metabolism. Their powerful anti-inflammatory properties is why they are used for RA since it involves inflammation out of control caused by an auto-immune response. They are used for so many diseases and symptoms…basically anything that involves inflammation. But long term use of them brings about many unwanted side effects so they are usually used short term…like the shot you received. The steroid was injected locally (sounds like into the hip) probably in an effort to knock down inflammation in that joint and provide you some relief short term. It’s not uncommon to have some worse pain in the injected joint for 24-48 hours after the injection before the steroid starts working. Some people will get a few months of relief from a steroid shot. I’ve had some shots where I didn’t feel anything and others that have been quite helpful.

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  • By Dixie_Darlin

    Thanks, Dr. Andrew. I received two Kenalog-40’s in the buttocks. 🙂 It had been longer than 48 hours so I called the office today to question the pain. I was told that sometimes the shots don’t take or wear off in a day. It’s not the norm, unfortunately, she thinks that’s what has happened. She also said the pain comes back with a vengeance so that may explain my increased pain level. I cannot wait till I have my next appointment on January the 8th! Thanks again. Have a good evening.

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  • By Dixie_Darlin

    Hi Dr. Andrew, just a quick follow-up. Had my appointment on January 8th and was prescribed Methotrexate 2.5 pills, take four the first week (10 mg), five the second week (12.5 mg), and six the third week (15 mg), then maintain this dose each week. I am to take 1 mg Folic Acid each day. I will also continue the Mobic 15 mg until the Methotrexate kicks in.

    I took my first dose on Friday evening and had a bit of nausea. Today, two days later, I’m rather tired, but have been mostly resting this past weekend. Just wanted to follow up and to thank you again for your time.

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  • By Andrew Lumpe, PhD Moderator

    Hi Dixie, glad to hear that you’re on a treatment plan. Methotrexate is a disease modifying drug and hopefully it will slow down the progression of RA. Keep taking that folic acid as it will help with side effects. Nausea and fatigue are common with methotrexate so hang in there. Mobic can be an effective NSAID for controlling pain and inflammation. Hope your stomach can handle it. I loved how Mobic made me feel but my stomach can’t handle NSAIDS. Thanks for the update. Andrew

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  • By Suzan J Pryor

    Hello! Although I’m new to rA.net, I’m not new to RA. I have had a hard diagnosis for 13 years now, but looking back, it was a problem long before. My problem now is that I live in a very rural area, and there are NO Rheumatologists within 150 miles of me. I do have a good primary care Dr (a family Dr), and although he seems very compassionate, I think he is afraid or perhaps just not informed and we are now just treating symptoms, with no DMARDS prescribed. Due to a long fight with Hep C years ago (it was during blood work for RA that the HCV was found), I have never taken any biological modifiers. But I was on an injectable methotrexate prior to moving to live with my grown son, who also fights auto immune issues. I am 64 years old, I exercise regulary, am not overweight. . . all of my tests have always shown a very active disease, and I certainly know that. I can see disfiguring damage to middle joints of fingers and have a lot of back issues. Fatigue is as much of a problem as pain—sometimes the fatigue is harder to battle, and keep depression at bay. Is there some way I should talk to my primary care Dr about a DMARD? I sure don’t want to tell him how to do his job, but I feel this is important. I have no way to travel the distance it would require to go to a Rheumy, my experiences with them in the past haven’t been good, due to the mixed mess of Hep C and RA–since most newer RA drugs do involve suppressing immune system. My last blood work in Oct 2013 indicates the HEP C isn’t an issue, doesn’t show (YEAH!!) THANK YOU FOR any thoughts Grandmama Suzan

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  • By Andrew Lumpe, PhD Moderator

    Suzan, welcome to the site. I would encourage you to talk to your doctor about treating RA as it is critical to get the disease under control before it causes major damage. If you can’t get to a rheumy, you could share treatment info from this site or from the American College of Rheumatology.

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  • By Mariah Z. Leach Moderator

    Hi Suzan – Thanks so much for taking the time to share your story. I can certainly understand your frustration at not having access to a rheumatologist – unfortunately it is a problem for too many people suffering from RA. And while I also understand that you don’t want to tell your doctor how to do his job, part of his job is making sure that YOUR needs are met. If you have questions about different treatment options ask them! It is your doctor’s job to make sure that YOU are happy with your treatment plan and it is also his job to answer any questions or concerns that you might have.

    So you have every right to ask your doctor about DMARDs and biologic medication options – and if your doctor doesn’t know the answers you should ask them to please find out. Even though you may not be able to travel to a specialist, perhaps your primary care doctor could consult with one. For most people with RA, DMARDs are important for preventing long term joint destruction – and finding a biologic that works can make a huge impact on your quality of life.

    You may also want to check the American College of Rheumatology directory: http://ww2.rheumatology.org/directory/geo.asp Maybe there is a rheumatologist closer to you than you think!

    Best of luck!
    ~Mariah~

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