How common is it for joints to self-fuse after they have been damaged by long-term RA (well managed now but I have damaged joints)?

[Pands]

Does anyone know? I now have another joint (bits of my ankle/navicular bone) self fusing and I wondered if this is something anyone else has experience of? I now have one fused wrist, one partially-fused other wrist, 2 finger joints, top of foot and as of yesterday I found out I seem to have a partially fused ankle/navicular bone. I will ask my Rheumy next time I see him but that isn't until the new year.

It appears to follow the the same pattern: the joint/s are massively painful and grind together and then by the time I have been seen by drs, had investigations, seen rheumy, had x rays and steroid injections and splints etc etc etc and finally finally given up and can't cope anymore and I am referred to see the surgeon, the joint has self fused. Biomechanics person yesterday looked a bit bemused at the mess of my lumpy fused ankle.

[Kittykatxxxxx]

hello Pands

I havn't got an answer but I can imagine that a fusion happens when ra is uncontrolled for a long time. I think it is individual some can probably get away without fusions etc others are unlucky and the fusion can start relatively quickly. Anyway take care x

[Pands in reply to Kittykatxxxxx]

Hi, yes it does seem to be in the joints that I knew had damage from when my RA wasn't managed well. Just another thing to add to my list of ailments

[earthwitch]

Fusion is a hallmark of spondyloarthritis, mainly because spondy has a slightly different mechanism for the inflammatory reaction that seems to trigger bone remodelling, particularly at the enthesitis points (points where tendon joins bone). That,s what happens particularly in the spine with syndesmophytes developing that eventually cause the vertebrae to join together if inflammation remains uncontrolled, and also in the sacroiliac joints, but its possible in any joint where there has been a lot of uncontrolled inflammation at the entheses.

Are you seronegative or seropositive for RA? If you are seronegative, it might be worthwhile seeing if you could get a second opinion from an ankylosing spondylitis specialist to rule out AS. Treatment for AS is slightly different from RA (i.e. DMARDs don't work anywhere near as well), so if it was actually spondy, then getting treated more appropriately might help avoid any more joints fusing. Check out the information sheets on the nass.co.uk website too, to see if you think that might fit better than an RA diagnosis. Of course it is also possible to have both RA and AS at the same time.

Another thing you might want to do a bit of reading up on (or ask your rheumatologist or orthopaedic specialist) is the advisability of having any more steroid injections into tendons - from my understanding steroid injections right into the joint are fine, but they are now realising from recent research that steroids into the tendon can cause tendons to become very brittle and end up with even more damage to that area (more inflammation = more bone remodelling).

[Pands in reply to earthwitch]

Really interesting thoughts thanks earthwitch. I did wonder about some sort of spondyloarthrits as well but I don't really have back pain as such and I am seropositive RA - have had it for about 15yrs - diagnosed in my late 20s and before anti-TNFs were around and I knew I had a lot of damage before it was controlled properly with the humira/mtx etc routine.

The joint fusing has only happened since my RA has been well controlled -so over the last 5 years. I seem to be averaging a fused joint every year or so. The steroid injections I have had have only been into joints to relieve the joint inflammation so I am not too concerned about the tendon side of things (though I do have some tendonitis as well now). I will take a look at all the links thanks. It is so frustrating as I didn't get a good explanation from my Rheumy at my last appointment when I asked about the ongoing pain in my foot and now by the time I see him again it has fused in that place and now the joints across the top of the foot are painful and I imagine they will do the same thing! So frustrating.

[earthwitch in reply to Pands]

Might be worth a more direct question to your rheumatologist about whether it could be spondyloarthritis in those fused joints, or asking if it was worth having a second opinion consultation with a spondy specialist? The back pain is an odd one. Yes, its a hallmark of spondyloarthritis, but for some folk it can be in very limited areas - just sacroiliac joint, or just neck, etc. Also if it was one of the other forms of spondy like Psoriatic arthritis sometimes the back involvement is also very minimal. Would be lovely if you had a rheumatologist that would take the time to really answer questions, but in the NHS they are like hens teeth.

[Pands in reply to earthwitch]

That's interesting - because the only place in my back where I do have pain/lots of stiffness (where I sometimes can't stand straight until it wears off) is right at the base of my back/spine - so sacroiliac joint I think. Thanks I will speak to my rheumy. My rheumy said last time i had lots of secondary osteoarthritis and that was causing the pain, just no explanation as to why the joints were fusing.

[nanamae]

Hello,

I had trigger finger surgery in January and now have a self-fused finger knuckle. My hand Dr suggested I get tested for RA so I did and they said I do not have it. I have severe pain in my lower back and joints most of the time with swelling in some places. I am so frustrated to not have a reason or diagnosis for my finger joint being fused and all the pain that I am in all the time