Sharp pain in one finger and node appearing; also jaw pain like TMJ-- what to do?

[RichDC]

Hi all, just joined the group. I've been on RA meds since 2018, take Cimzia, methotrexate, sulfa, but in the last few days developed a sharp pain in one finger on my left hand, as well as a node on that finger. Also been experiencing jaw pain that seems like TMJ. I have an appointment with my RA doc on August 31; should I get in to see him sooner Are these signs my meds are no longer working? Thanks for any advice.

[MadBunny]

RA can affect the jaw , although you could maybe ask your dentist about the pain. I had it and it was caused by me grinding my teeth in my sleep , so she made a special gumshield for me to wear. Re your finger- I would say it's worth seeing your doctor earlier if you can .

[RichDC in reply to MadBunny]

Thanks MadBunny will do.

[Gnarli]

Oh poor you that sounds horrible. In your position I'd like to see the rheumatologist sooner rather than later. However, as MadBunny has suggested, asking your dentists opinion on the jaw pain could be useful. Night time teeth grinding is surprisingly common.

[Fergie432]

Nodes unfortunately a side effect of RA, painful when they first appear and likely to calm down after several months, I have a few.

[RichDC in reply to Fergie432]

It did subside— thank you!

[Runrig01]

I have ankylosing spondylitis, but get peripheral symptoms. Last year I had several painful nodes appear on my fingers, which eventually subsided after many months on their own. My AS affects my jaw, my rheumatologist was skeptical but my dentist referred me to an Oral Medicine Consultant at Guys, who confirmed the jaw pain was due to my inflammatory arthritis. I also got painful vascular lesions on my tongue, as well as pulsatile tinnitus and tender scalp above and behind my ear. He explained all the symptoms were due to the inflammation in the jaw pressing on nearby vessels and nerves. My methotrexate was increased and symptoms subsided. My jaw is still painful chewing certain foods, and my cheek muscles are always tender, he did also refer me to a specialist physio who specialises in the jaw joint.

I’d recommend seeing your dentist first, to rule out grinding your teeth as a potential cause. My experience of several rheumatologists is they are skeptical and dismissive when you mention the jaw, and initially are likely to suggest seeing your dentist. Seeing before your appointment puts you in a stronger position, as you can say dentist has ruled out any of the usual dental problems contributing to it. Good luck 🤗

[Silentreader in reply to Runrig01]

For the pain in your jaw maybe a bite splint would help? "A bite splint is a dental appliance typically made out of acrylic that covers the teeth on one arch and can be made to manage a number of different dental conditions. Bite splints can be made out of hard or soft dental acrylics. They are typically custom-made, but there are over-the-counter varieties as well."

I have had one for years due to arthritis. I had a serious accident when I was almost eighteen and my jaw broke - along with a lot of other parts of my body. At the time I was singing in a band but gave up singing due to the jaw problem. I wore the splint for many years (and still do) and then started singing again about eight years ago. And found it to be therapeutic unless you sang something where you had to open your mouth too wide - something strenuous. The bite splint - I think better than the over-the-counter variety, is to have a dentist measure out the perfect one for you. I only wear it at night to stop the pressure. It has helped me a lot - I am now 73.

[Runrig01 in reply to Silentreader]

Thanks. I have had a custom made bite splint for years. It does help when my jaws spasm and eases the tension. However I do find when the inflammation in my jaw flares up, the only thing that helps is adjusting my MTX dose. I personally find the jaw massage technique more beneficial than my bite splint, and although I can tolerate the splint during the day, I always seem to pull it out in the night, and take longer to get to sleep when wearing it. My specialist said as it is inflammatory causes the splint will only at best provide temporary relief, and that controlling the inflammation is the only way to really manage symptoms. I’m currently struggling with tongue pain, due to the inflammation, making it difficult eating certain foods, and clearing food from my mouth due to restriction in tongue movements. It even twitches when I lie flat, and randomly curls in a spasm, all due to inflammation in the jaw. Apparently I am an extreme case, and something to do with narrow tubes, and the inflammation affecting nerves and vessels running close to the jaw.

[Silentreader in reply to Runrig01]

Hi Maureen, I have worn the splint for years and only at night because it is when you sleep that you really press down I was told. I just looked this up - "When worn, splints allow jaw muscles and ligaments to relax, therefore preventing the occurrence of teeth grinding, clenching or other jaw reactions that may trigger TMJ pain and discomfort. Aside from teeth grinding, or bruxism, it's hypothesized that TMJ disorder can also stem from either an underbite or an overbite".

Apart from having a horrific traffic accident when I was seventeen and a half, which almost cost me my life, I suffered a broken jaw and broken, hip, knee, pelvis and shoulder. And I also have an overbite so my jaw is not in alignment.

I am English but left London at the age of 21 to work for the French Consul in B. and then met my husband and stayed and so I have lived here for the last 50 years and do not speak English on a day-to-day basis anymore. The country is not France. I do not know if it is a good idea to write a lot of details about where I live and so on.

No family left in Britain either. I don't really know the difference between a dental splint and a dental guard? Is it not the same thing?

All I can say is that I was told to wear it at night only as that is when all your worries of the day cause you to press down hard.

Jaw clenching is usually caused by emotional issues like stress and anxiety. Muscle tension is a common symptom of these emotions, which can include a consistent clenching of your jaw I was told by my dentist who also specializes in these kinds of problems. I was told it usually occurs at night when you sleep, so I did not have to wear mine during the day.

I have arthritis in my jaw, due to the damage and the splint has helped me enormously. I go to one of the best dentists around. We are privately ensured - and even the young girls who assist him, some of those have a splint that they wear at night. They said it has to do with the times we live in and all the stress of the job and fast living. This country is a very hectic country so it doesn't surprise me. But I think also the overbite. Had I been born later I would probably have worn braces as a child to have that corrected.

For me, it was the damage of the accident but also living in this country which I have grown to dislike. I was very homesick and in the 70s a lot of old N...s still among the living. All was ok in B. as it is a mixed city but then we moved to my husbands home town in the south. A mainly catholic town but people were unfriendly to foreigners. I was the only foreigner apart from an Italian pizzeria, living there. Very religious, but the milk of human kindness entirely missing.

They particularly disliked the English because the city had been bombed by the British in retaliation for Coventry in the war. I was born later so I don't know what any of that had to do with me.

Anyway, we moved north after 18 years. All the mobbing stopped because we now live very privately. I have no doubt that people are still similar but at least they leave you alone and do not attack you openly. All the worry, especially over my girls who also suffered, is I am sure part of the problem with my jaw. So for me, the splint was and is a lifesaver.

Anyway those are my experiences with the splint. Mine looks like this just to make sure we are talking about the same thing -

the dental splint

[Runrig01 in reply to Silentreader]

Thank you for your reply. Yes my guard is the exact same as yours. I was seen by 2 professors in Oral Medicine, one in Leeds who provided the first guard, then several years later at Guys in London, where I got my current guard from. Both say there is no evidence of tooth grinding or clenching, and have no over or under bite. I’m fortunate that I’m retired and leading a relaxing life, so stress isn’t part of my day to day life. On the whole when my methotrexate is at the correct dose, my jaw gives me no issues. At the moment I’m on antibiotics so have had to stop MTX and my biologic, which has resulted in the muscles getting tense. I do take a muscle relaxant Baclofen which helps, and I know once back on my meds this will subside again, so I’m really not too concerned. I’ve lived with these flares of the jaw for 9 years.

[Silentreader in reply to Runrig01]

The photo of me is from long ago and my jaw problems started when I was in my thirties. I am now 73. I understand it then that you have muscle tension for some reason Maureen? I speak French and German daily and so have a problem with English since I stopped working. My pain has been with me in one form or another since I was about 22. The people from the hospital told me that my hip was like that of an eighty-year-old woman at that time. But I have strong bones. It is partly regarding joints where the damage occurred. Hip, knee, shoulder and spine. At the time I was told that I would end in a wheelchair by the time I was forty but it did not happen. That was because there was no hip replacement or knee replacement then. But I still had my children although advised against it and led a pretty active life even skiing down easy slopes. But I usually had pain after doing something strenuous or lifting. Even lifting my children when they were little and have always had to watch my weight.

Most medical terms in English are not known to me or not as many as I would have known had I spent my life at home so I have to google whatever it is often.

My jaw pain is also tension, stress and worry. Of which there has been a lot as one of the children is handicapped.

I now also have asthma although I never smoked but many people in my family did so it is probably secondary smoking..

Despite the prediction on that one in hip in particular it lasted until I was 67 so I think doctors do not know it all. I do not take medication for the pain usually but do have acupuncture treatment and try to relax by listening to relaxing music or doing something like acupressure myself. My daughter is a doctor and Psychiatrist and she gives me acupuncture treatment and does it so well that I often fall asleep during.

Like you I can feel the inflammation in the form of heat when there is pain. That also happens when I sing. I was at one point in my life a professional singer and had training but I cannot sing anything that is difficult or a too high key anymore. I watch what I eat. Nothing too hard like nuts or nothing extremely chewy. I still have all my own teeth thank goodness as I think drawn out dental treatment might not be so great with this problem so hope they will last me. Hard enough keeping my mouth open with fillings of which there are a few now. And I had lock-jaw once and since then cannot open up very wide.

Hopefully, you will be alright. There are always worse things in life, but of course, for all of us, it is our own particular situation and that is human. Take care,

Nica

PS please forgive if stilted or unnatural English. As said I hardly use it now.

[RichDC in reply to Silentreader]

Thx Silentreader, I have a night guard; is that the same as a bite splint? Don’t always wear it but will start!

[Silentreader in reply to RichDC]

Hallo RichDC. I think it could be the same but am not completely sure. I have lived abroad for 50 years of my life and hardly speak English these days. Mine was prescribed for me to stop me pressing my teeth together at night. Due to stress largely as I had a bad time over here in Germany when we left Berlin, where I worked for the French Consul, and moved to my husbands home town in the south. A lot of the old N...'s were still alive then - in Berlin you do not notice it as it is very cosmopolitan but in Würzburg which is a catholic town with hardly any foreigners then - I stood out like a sore thumb. Due to this and which carried on until about 1986 so for 16 years I must have started to press down in the night which was bad for my jaw. My jaw broke due to an accident when I was very young and so this night guard really helped me as it stops your teeth from meeting. I know there is something that looks similar but that is to straighten your teeth I think. I only wear mine at night and it is enough. Maybe you will not have to wear yours in the day either. All the best with it. Nica

[Hairbraid]

I’d go sooner any new pains and with jaw I saw a dentist about 18 months ago my rheumatologist sent me too a dental hospital sadly mine is part of my rheumatoid but it can be TMJ and they can help you X-rays at dental hospital and try you with mouth shield at night if it is grinding go sooner longer you leave pain gets worse I’m still trying now to find a medication to work take care love jane