knuckles for Neonkittie

[Brychni]

the pain from that middle knuckle was going both directions

[allanah]

Ouch xx

[Downtime]

I know the feeling. It’s relentless when it starts and goes right to my elbow. Thankfully I only get bouts of it every so often.x

[sylvi]

My right hand is so very sore and especially the middle finger on the right hand, but i have to say yours look very sore.xxxx

[LinaM]

Ooooooh they look sore 😩

[Brychni]

I hope this description gives others some idea of how to articulate pain during appointments.

It's such a small are of the body and it doesn't hurt all the time but my God when it does it's horrible. So hard to describe but the best word I can come up with is 'stingy'. A bit like stinging nettle pain and yes it also goes up over my wrist, top and underneath and to the elbow and as I said, I can then feel it on the side of my face, under my ear and neck and then it's like goose bumps, makes me a feel a bit cold. I had it in my right foot too and that went on for days none stop, in bed at night, when sitting, when walking, when standing and that's when I said I would have the steroid injection. The pain went over the top all the way to the tip of my toe and underneath my foot, around the rim of the heel, up the sides of achilles tendon, all the way to the sides of my knee.

[Neonkittie17]

Hi Brychni, yes they look sore especially the nodules on the knuckles. That can be a sign of RA of course but I thought that nodules appeared further down the line with RA. I’m not sure as I’ve never had those but I know some people have them often and they can come and go. Be softer or harder. The nodules can press on the nerves of course, sending shooting pains.

I can see you have still got definition in your knuckles on the hand. Mine were just a puffed up mess and still have a little of that between too knuckles where there is no undulation, even though my ESR and CRP are under 5/zero. It’s strange how some things disappear and some don’t. I think your fingers on the right hand are indeed different to your left one on your previous photos. I hope you can decide what to do but I will say that uncontrolled R.A. due to not taking the meds the rheumy wants to you is not a good thing as it is a systemic disease which affects much more than your joints if you let it get out of control. You are allowed to ask to change to something else if your side effects are intolerable. No rheumy is going to keep you on something that makes you have many more problems but you have to give something a fair chance. Sometimes you can have a small reaction which disappears once you are accustomed to taking your med. As was said, the rheumy would have to have other evidence and be very sure you were in need of an R.A. med to prescribe it. I had an isotope bone scan to distinguish “hot spots” on my joints. They corresponded to my areas of pain.

I would keep a note of how and when things hurt and feel but not doing it all the time or producing an essay as such for the rheumy! 😜 I call my R.A. pains .. electric shocks .. as they are so acute and quite a violent pain and often out of the blue when they strike, like someone has wired me up to electricity across the back of my hands. I don’t get too many of those but had a few lately as I’m overdue an infusion. They last only seconds but keep returning for around 15 minutes, but not like you describe with nettle stings. x

[Brychni in reply to Neonkittie17]

Hi Neonkittie - I get the sharp shooting electric shock pains too often in my fingers but usually in the side of my face near my eyes.

It's typical isn't it - I felt fine yesterday but had a bad night with the ear pain thing. Had to get up and take another naproxen. 🙁

[Brychni in reply to Neonkittie17]

Forgot to ask - what exactly are 'nodules'? I too have read about them but can't get any detailed information. I have hard and slippery but loose lumps near my elbows which sometimes feel hot when the pain is bad there but they are nowhere near to or attached to bones. They are loose. The lump I have on the top of my wrist I think is probably a ganglion cyst because it comes and goes but it does cause pain when I bend my hand up. It's solid with only the tiniest bit of give.

The lumps in my knuckles are rock hard but unlike the lump on my thumb and little fingers have come up really quickly, a matter of weeks, all other lumps have been growing for years. It feels like deformity and unlike what you have described, there is no swelling, only redness when they become painful - which is on and off!

[Neonkittie17]

You haven’t got ringing in your ears have you as Naproxen can actually cause that. 😑

[Neonkittie17]

Hi, this is from the NRAS info page on those main site. Hope it helps. As I said earlier I had been told the nodules were usually present more in people who had had R.A. for some time. Has your rheumy commented on them or seen them? If you’ve had other nodules or lumps/ganglions prior to your current/recent health issues then it could well be they aren’t rheumatoid nodules and are harmless cysts. I would let the rheumy see them if you haven’t already done so as they should be able to tell you if they are rheumatoid related.

What are rheumatoid nodules?

Rheumatoid nodules are firm lumps that appear subcutaneously (ie under the skin) in up to 20% of patients with rheumatoid arthritis. These nodules usually occur over exposed joints that are subject to trauma, such as the fingers joints and elbows, though occasionally they can occur elsewhere such as the back of the heel. They are usually non-tender and only occasionally painful and very rarely the overlying skin can become infected or even ulcerate. Rarely they can occur in the lungs and vocal cords.

There is a suggestion that the incidence of rheumatoid nodules is falling (possibly due to the reducing severity of rheumatoid arthritis) but nowadays they are most commonly seen in patients commenced on methotrexate therapy in whom the nodules that develop tend to be small and multiple (micro nodules) most commonly around the finger joints. About 8% of patients on methotrexate develop micro-nodules and we don’t really know why. The image with this article shows a severe case of rheumatoid nodules. Micro-nodules are normally slightly smaller, at around 0.5cm across.

Rheumatoid nodules are very firm and are made of inflammatory tissue, but under the microscope show intense inflammatory changes that are different from the ones that are found within the joints. This explains why disease modifying drugs and biological therapies may not reduce the size of the nodules even though they may have an excellent effect at controlling joint disease.

Who develops rheumatoid nodules?

Patients who develop nodules are more likely to be smokers, tend to have more severe disease, are almost invariably rheumatoid factor and CCP positive. They are more prone to other extra articular (meaning outside of the joint) features of rheumatoid, including vasculitis (inflammation of blood vessels) and lung disease. Very occasionally rheumatoid nodules can develop within the lungs. These are usually asymptomatic (ie you would not experience any symptoms from this), but can cause concern to doctors because of uncertainty about the diagnosis and may require additional tests such as a CT scan.

What can we do about nodules?

There is little research in this area. Combination disease modifying therapies and the biological therapies, in particular rituximab, seem to have reduced the incidence of nodule formation. If micro nodules develop while on methotrexate then the addition of hydroxychloroquine and other disease modifying drugs including prednisolone may reduce their size.

If nodules are small they can be ignored. However, if they are subject to repeated trauma, surgical removal is an option. Occasionally, injection of steroid into or just under the nodule can reduce their size.