I went to my dr today. Suffering for the last couple of months with stiff fingers in both hands and for the last couple of weeks they have been feeling a bit warm.
She confirmed that from the look of my joints that they are nodduly and that I’ve more than likely got OA, but they’ve been like that for years. I’m 52. She also said that OA can get warm from a flare up.
I had bloods taken but I’m a bit confused as she explained that the test is not definitive.
So what if I do have RA looming but I get a negative result? That will mean a delay in treatment if I need it.
My anxiety is therefore sky high as I’ve read some scary things about RA
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Seton
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Hiya Seton, welcome. Firstly, stop reading, please! The internet is a minefield, lots of dross & outdated info out there not to say scaremongering so please stop searching. If you must do keep to reputable sites such as NRAS nras.or.uk or Versus Arthritis versusarthritis.org/about-a...
Ok, now, your affected finger joints, which are they because that can be telling? Your GP is thinking it's more likely OA, those would be the DIP joints, or Heberdens nodes, those nearest the nail, or, in the thumb, Interphalangeal joints. If they’re RD (Rheumatoid Disease or RA) affected they'd be the PIP joints, or middle ones, or the thumb Metacarpophalangeal joints. Also RD would be the knuckles... if inflammed if you tried to make a fist you wouldn’t,t be able to make out your knuckles. Stiffness of fingers isn’t really helpful as both conditions can cause this, as can warmth which is due to the inflammation.
The blood tests aren’t definitive unfortunately, only a Rheumatologist can diagnose RD from the blood test, imaging & examination. OA is often managed by your GP, though not always, as this doesn't require specialist medication. The blood tests she'll be ordering will be RF (Rheumatoid Factor) which I’ll return to & inflammatory markers CRP & ESR, both chronic (long term) & acute (actual) inflammation. It's not an overly reliable test, a more accurate one is usually taken by a Rheumatologist on referral, that's Anti-CCP. Now this is where it gets a bit odd, you can have an RF score even if you don’t have RD, a percentage of the population does. However you can have RD without scoring RF, this is what's called seronegative RD (conversely seropositive is a, usually high, RF score), the more common type. Both are treatable with specialist meds, NSAIDs etc. More info here nras.org.uk/seropositive-se...
So, really it's a case of waiting for the bloods to come back to see if your GP determines you should be referred, until then anti inflammatories will work for both conditions on bring down inflammation & pain. You could try a topical cream/gel such as Volatarol (diclofenac, either 1.16% or 2.32%) or if you prefer something non medical Pernaton gel can help ease pain, I use both intermittently but you don't use both gel & tablets (NSAIDs) together. Your age isn’t really helpful as both OA & RD can be diagnosed around this age, I was a little younger, 48, when I was diagnosed with both, pre menopause.
If you feel you'd like further information or need more help from reading through the NRAS (for RD) & Versus Arthritis (OA) sites please ask rather than rootling through Google, it's better believe me, you'll only scary yourself more & stress isn’t good for either.
Thank you nomoreheels....I appreciate the detailed reply. Google has scared the life out of me...from getting strokes to heart attacks , that’s why I came here - to get some real life advice.
My joints. My DIP ones look nodduly and my index and middle finger are a little off centre :-).....but again, been like that for years. I think my PIP joints look ok.....
I think what convinced me about RA was the warmth....I thought that was the red flag but it seems you can get that with OA.
Just out of interest, if they do come back negative and the dr wants to take a wait and see approach....would that be ok?
You're welcome. This is why I asked you not to go online, there are so many rubbish sites out there, they paint a pretty poor picture. Whilst some of it is possible, RD can affect not only our joints but our internal organs what's often omitted is that it's as a result of poorly controlled RD, or just not responding to meds many years down the line. This is why it's important to have as an early diagnosis as possible if it is RD. Unfortunately some sites seems to revel in only pointing out the negatives & not the positives of which there are plenty.
From your description it does sound more likely to be OA but without seeing we can't call it. I'll try & post a pic of my fingers, see if they are similar to yours. Yes, both can feel warm to the touch.
If the bloods come back negative she may want to wait & see, it somewhat depends on how up to date she is, but only if nothing else matches the criteria. She may ask other questions such as is there anyone with RD or other autoimmune disease in the family (my Nan did), if you’re stiff for around hour in the morning (possibly multiple joints) but they ease (OA affected joints tend to remain stiff), symmetry (joints tend to be bilaterally affected but not always). If the bloods are inconclusive she may refer anyway, it depends.
Yes, please do keep in touch, let us know the result. Fingers crossed it's all ok.
That’s right, there is no definitive test for RA. There are two antibody tests that give an indication, but neither are 100%. The best one is the anti-CCp antibody test, but that is still not a certainty. And you can be negative for one or both tests and still have RA. This is called being sero-negative.
However most doctors won’t make a diagnosis on a blood test alone. Usually they need a combination of physical symptoms, blood tests, family history, how you say you feel and how the symptoms have evolved over time. Yes it is harder to get diagnosed if you are sero-negative, but cross that bridge when you come to it.
For the moment just keep a diary of symptoms, and try not to stress (it will make it worse). RA can be scary for sure, but most of us here are living perfectly happy and pretty normal lives. Just avoid Googling! There’s a lot of rubbish out there!
Thank you Helixhelix......yes the dr did say it’s a combination of factors.
I just got concerned as there seems to be a sense of urgency to get medication if you have RA. So if I was sero-negative that could mean I could be delayed with treatment and be worse off in the end? Or is this not the case?
It so depends on the doctor and what conclusion they come to about your symptoms. If they are classic and obvious then whether you are sero-negative or positive generally makes no difference whatsoever. So things like hot swollen joints on both sides of body, raised inflammation markers, and morning stiffness that lasts a while are as important as antibody tests.
However if your symptoms are less clear cut then you can struggle to get a quick diagnosis. Sorry! But it’s also likely to mean you are at a pretty early stage, so may not make much difference in the long run. In these cases you need to push to get an ultrasound which will show inflammation.
Please stop reading Dr Google...you will probably only scare yourself silly because you won’t understand most of what is written. Plus most of the info is out of date.
Your best bet is to look on the NRAS site & read some of their leaflets.
I have had sero positive rheumatoid disease (arthritis) for more than 20 years & although it’s not a walk in the park, I’m still firing on most cylinders!
It might take a while...maybe a year or more if you are diagnosed with RA/RD.....to find the right drugs, .but these days there are so many choices of drugs you will definitely get some treatment straight away.
But do be prepared for a longish wait to get a rheumatology appointment.
Just a question, what do people consider scaremongering? Is it the personal blogs? Cos mostly the people who blog have the most severe cases, and so their disease progression is pretty scary, but its not at all typical. I'm wondering if personal blogs help or hinder, if anyone has any thoughts? Actually I might start a new thread for that topic....lol. To OP, to be honest, it doesn't sound like RA from your description. But it still could be, so you've done the right thing, and your doctor is on top of it. Rest assured if it is RA, you've caught it early and its mild, which gives you an excellent prognosis. Try not to worry, because the chances of you having serious disease is very small, which is not to dismiss your fears, but to reassure. Take care, and keep us posted xx
Hi Seton I was diagnosed with sero negative RA about a month ago - which really means that my bloods for Rheumatoid Factor and Anti CRP came back negative. However I had a lot of stiffness in various joints and then both my knees and both my wrists got very inflammed/swollen and knees in particular very painful; this was followed by problems with my fingers and thumbs(thumbs in particular swollen and sore), feet and shoulders / neck. All symmetrical i.e both sides of the body. - so I think that is very important. GP did bloods but when I rang up to get results I was told they came back negative so I didn’t have RA. I knew myself something wasn’t right because so many of my joints were swollen and painful so I went private to a rheumatologist (I had health insurance) and he examined joints and did ultrasounds which showed significant inflammation in the knee and wrist joints and he diagnosed sero negative RA. Note however that I presented with issues in a number of joints - in your case it is just your fingers and I noticed when he was checking my finger joints it was the middle ones and the knuckles which seems to tie in with the reply from nomoreheels about difference with OA.I asked him how long a referral via NHS would be and he said that if they get one saying RA suspected then it should be fast tracked - and I think he said 6-8 weeks but I’m not sure if that is what actually happens. If you remain worried if your bloods come back negative I would try pushing your doc for rheumatologist referral. I’m currently waiting to see my rheumatologist now via NHS although he has started me on treatment. He also told me that whilst no cure that the drugs now are almost akin to one as they are very effective but can take time to get right. I did Dr Google big time and it totally wrecked my mind (to put it mildly!) and as others have said I think a lot of the info is out of date and conflicting. So avoid if you can. I rang the NRAS helpline at start when I was really worried and was speaking to a very helpful lady who was knowledgeable and put my mind at rest a lot. Hope you get on ok and do your best to stop worrying 😊
I had an inflamed finger, stiff hands in the morning and pain throughout my joints, which made sleeping difficult at night. After reading some stuff on the internet I got a food reaction test which indicated a reaction to egg yolks, wheat and oats. Cutting wheat and espcially oats out of my diet meant the inflammation went down. My test was a Cerascreen one which is about £100. So it is worth doing a food elimination diet. If I ever stray and have too much wheat or any oats I know about it.
I had hands like bunches of bananas, swollen knees and ankles. my then GP did the bloods which were negative but he was certain I had RA. So after a few months on NSAIDS and no improvement he referred me to Rheumatology where I was started on DMARDS. I was seronegative, but 32 years later I'm now seropositive.
Does't sound much like RA, in my opinion. Two overriding symptoms are:
1. Disability
2. Rapid onset
Also, multiple joints or tendons are affected and it feels a damn sight worse than warm joints.
Are you dropping things, unable to turn a tap or a key or a handle, unable to pick up coins, get dressed, do up buttons, pull zips, get tights on, pour a drink, cut food? If you have no loss of function, it seems unlikely.
When I developed RA, I woke up with stabbing pain in middle thumb joint of right hand and the index and middle finger jammed. The next day the wrist was affected. Ten days later the left hand was affected in the same way and the right hand a bit better (which is class RA symptom). Then the elbows went, one developing a large lump, then the shoulders. A few weeks later the knees were affected, the lower left leg went numb and the foot arches and toes were painful.
Blood tests are only a guide - various factors cause inflammation such as diet, alcohol, obesity, lack of exercise, age. Therefore, you could have normal blood tests and still have RA if you are young, slim, exercise a lot and have a healthy diet. It would be best to try ad get ultrasound done by the GP - they are remarkably slow (well some of them are) at ordering the most basic tests. With regard to the hands, it is usually the middle joints and the knuckles plus the thumb base and wrist. Ultrasound will show what the nodules are. In my case, there was an RA on the middle joint of the index finger, two grisly ones on the end joints which were just bone and a fleshy one on the wrist. You could get blood tests done to rule out other conditions such as gout which would put you closer to a diagnosis.
It could be almost anything including an inset bite or an allergy.
There are various pain killers for OA and RA, eg devil's claw which I found about 70% effective though not sure it did anything much for swelling. You could try electro acupuncture as it worked my hands really well - after 35 mins I could move my fingers which had been jammed for 9 months.
Thank you for your reply. You provided a list of things asking if I could do them? Yes I can do all that....but wouldn’t RA have an early stage or someone have a mild case?
I’m fit and well, healthy diet and non smoker but it seems RA isn’t prejudice.
OA or RA, there is something going on so I’ll see what the bloods say and go from there. Dr said I did the right thing by going in
Seton you are right in stating that you could have early RA, I could do all those things that delicateinput suggests you shouldn’t be able to do when you first have symptoms. Everyone is different and every journey is different so you have done the right thing in getting it checked out. Please try not to get too anxious and scare yourself. See what the tests show and go from there. If you need us we will be here to support you. Everyone has their opinion but it is just that, their opinion and should not make you feel you shouldn’t be here or have done the wrong thing. Hopefully you will let us know how you get on. 😊
You have clearly misunderstood my post. If the fingers are the only part of the body affected, and they are flexible and mobile, there is nothing to suggest RA. If there were other joints affected, there would be - as in the case of people who do not get hand disabilities but who have other joints affected.
To be honest, would you seriously take drugs for a stiff warm finger? I wouldn't. RA comes and goes in flares, and I would rather leave it as it may never get any worse.
My thumb was the only joint affected early on and yes I did take drugs for it. Eventually I had bloods done and was diagnosed. I’m glad I didn’t leave it. Each to their own though. We’re all different 😊
Well we are but the crux of my post was that finger stiffness and warmth does not in any way indicate RA. It does not say much for the drugs if you took them and later went on to develop RA in other joints! RA often clears up on its own. My mother had it at a young age for six months. It cleared up and never returned without treatment. That is how I knew, in part, that I should keep moving and exercising.
I had a neighbour round to my house earlier on and I was composing letters for her to the DWP and Job Centre regarding benefits.
She had RA, and her shoulders and knees were badly affected - she had fluid drained off her knees. She went on Methotrexate. This was in 2014, the same year as I developed RA as described. She did not have my hand problems which caused me horrendous disability - her disabilities were her shoulders and knees which frankly can be overcome but hand disability could not. I could do absolutely nothing.
Two/three years later, she developed breast cancer which is now Stage IV and terminal. Her oncologist told her that the Methotrexate had triggered the breast cancer and she should not have taken it. She has never had any cancer in her family. It is annoying when it was not even necessary - her RA is no worse and she has not taken any treatment for it since developing cancer.
I am sure if she had followed the path that I did she would have been OK but it was a very hard road having to go to the gym and swim every day and pay for alternative therapies whilst I was not working. I know the problems with affected shoulders because mine were.
I would not dream of going on drugs like Methotrexate for a sore thumb and the rheumatologist did not want to give me any drugs as he thought I would not be able to tolerate them. It is such a pity she did not see him.
Anyway, it sounds to me as if Seton has a food allergy which is notorious for causing stiff fingers with nodules and warmth and redness. A friend of mine suffers from this and she was convinced for years it was RA. The foods affecting her mainly are ham and eggs. Another poster has suggested a food tolerance test which I think is spot on.
While it might not typically indicate RA it’s good setons GP is investigating it. We hear of so many people who have to fight to even get investigated.
I didn’t take mtx for an inflamed thumb! I took anti inflammatories which helped for a while before it progressed. There’s nothing wrong with taking drugs if they are needed.
The point of my post to Seton is that the GP is not investigating. Everybody knows that blood tests are not helpful at the initial stage - even NICE states that referral should not be delayed on account of negative blood tests.
There is a lot wrong with taking drugs. If there is a delay they often do not work (as stated by NICE) but you get the bad side effects. I have had side effects more serious than the condition itself and my neighbour is now dying on account of them. People need to be aware of that and not just blindly follow what GPs say - they are largely constricted by NHS budgets. To crown it all, I have recently been told that they are only allowed to refer a quota in a given time. I would say to go private but I did and all the private rheumy did was mess me around to the extent that I am left with a permanent illness that could have been treated in the early stages. By the time I got to the NHS rheumy, there was talk of a shoulder operation. I said to various friends that it is no wonder they have no money when they do operations that could be avoided but people seemed to think that was OK.
All I had was trigger finger when I was first diagnosed with PA......within two years that had morphed to full blown sero+ RA.
So if anyone has any unusual (for them) aches & pains or joints that feel different .....do see a doctor. I think it’s better to be sent off with a flea in your ear than to be the first one in the queue for a knee replacement.
Unfortunately there is no single classic RA symptom ...I bet we can all tell a different story about how we were first diagnosed......so if a joint hurts & a rheumatologist suggests taking a first line Dmard it should be considered seriously. It’s no good waiting until the disease has taken hold ....sadly many people only realise this when they need that joint replacement.
In this country we are incredibly lucky ....we have access...even if after a long wait.....to highly qualified consultant Rheumatologists without the anxiety of wondering we can afford to have the prescribed treatment.
Somewhat conflicting to say do see a doctor and do not wait but then you have to wait a long time. Mine came on dramatically overnight and I had to wait six months for an appt, only to have the Rheumy tell me it was too late. Not a lot of point going really, in my opinion. The GP wanted me to see a rheumy again and referred me again last July … no sign of any appt so I am not bothering. It is just wasting my time and theirs. They might as well close down if that is all they are prepared to do. I think the NHS is total crap and have nearly always gone private. Unfortunately, the last time I saw someone who was not competent but I was forced into that by the GP and the long wait. They only started to get their act together when they realised I could not get private treatment. Well, it is all too late now, as the damage is done and I never want to see any of them ever again.
I'm not sure about having a mild case. In my opinion, it is a pretty severe condition. Some cases are worse than others but the key symptom is disability, in particular in the hands. Usually, if your hands are affected, then so are your wrists and that will go to the forearms, elbows and shoulder.
I had an early stage and I woke up with stabbing in my middle thumb joint and my index and middle finger (all right hand) jammed. I could not bend the index finger in particular as there was a large nodule on it and the skin would not stretch. The whole hand was swollen. This was overnight. I was OK when I went to bed around 1 am.
I would not place much reliance on blood test results. Many, if not most, people with RA do not get blood test results showing inflammation for about a year. Mine did not show for six months and I suspect that was because I stopped exercising - I could not work and so went to the gym and swimming every day just to be able to move. The first week it came on, I had been expecting visitors and was polishing a wooden floor. I could not get up and I carried on polishing for two hours until I had enough flexibility to hoist myself up and that took five minutes. I could hardly move.
The quickest and most accurate test would be ultrasound and a GP can organise this. This will certainly identify what the nodules are. Even if they are not RA nodules, it does not mean you do not have RA. It moves very very quickly so I would be surprised at such a slow onset. Every day I had a new symptom. I was sitting at work two/three weeks after it started, and let out a scream because of pain in my right elbow. Everybody came to examine it and there was nothing there. Two hours later, there was a swelling like a tennis elbow. Of course I could not continue and had to give up work for nine months.
I find the NHS inordinately slow. I went private and the private rheumy told me it was gout - simply on the basis of a high uric acid reading and he thought all my nodules were gout topi. You really cannot guess - you need some imaging to be sure and ultrasound is relatively cheap compared with an MRI. The ultrasound will flash up any inflammation and a lot of other things. You won't have joint damage as that takes a long time.
The NICE guidelines do say that anyone suspected of RA should be seen within three months so that the drugs have the best chance of working. I did not start on them for a year, by which time I had almost solved the problem with alternative therapies, but I would say the drugs were about 50% effective. Quite frankly, you are better off without them. They might suit a lot of people but they have terrible side effects in many so if I were you I would press on with a diagnosis and try electro acupuncture which works on both OA and RA. It is available on the NHS but I'm afraid I have no confidence in them and went to a Chinese clinic.
You are of course perfectly entitled to you opinions....however the statement that “you are better off without drugs” should not be taken seriously by anyone newly diagnosed.
We should listen to our doctor & and if you don’t like what you hear get a second opinion.
I know some drugs can have dire side effects, but I’m sure many members here look back & thank their God that the drugs they take make their life worth living again.... know I certainly do.
I was replying to Seton with regard to drug usage.
Please wait for your blood test results and if you aren't satisfied you can ask for further tests to confirm your GP's diagnosis i.e. x-rays if OA is suspected.
Regarding RA, you should also check out our website for a list of articles on diagnosis: nras.org.uk/diagnosis
RA is a very complex condition which affects people in different ways, from the number and severity of the joints affected to the treatment, what works for some doesn't work for others. There is a very good range of medication to treat RA with only a small percentage of patients suffering from any side effects whatsoever.
As this is a forum, our member's are giving you their personal opinions and experiences which, as you can see, vary greatly due to the nature of this auto-immune condition.
If you are still concerned please do give the NRAS helpline a call on 0800 298 7650.
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