Can you get joint damage while in clinical remission?

[mjrminor]

I was diagnosed with sero-negative inflammatory arthritis five years ago and have been in clinical remission for about for four years. However, I've noticed over the last year my index finger has started to twist slightly, and in the last few weeks the knuckle bone of the index finger has started to protrude on the side. I'm definitely in more pain with my hands and wrists than I have been for a while too.

I've seen a nurse at my GP practice who examined both hands and decided to order x-rays, and my ESR and CRP levels were tested last week and they are both normal - they always have been, even at diagnosis.

I know this twisting is very mild compared to others, but my question is - should this kind of damage be happening if I'm in clinical remission?

My gut says no, unless it's some sort of erosion from damage done before I went into clinical remission.

[Hidden]

With the caveat that I’m not medically qualified. I’m not dismissing your concerns in any way, but was just wondering about your age? I have twisted and visibly deformed fingers as a result of OA arising out of untreated/unmanaged RD, but OA in the fingers is something that develops in lots of individuals as they get older. Had I been in my late 40s rather than my late 30s, I was told they would expect to see some visible changes in a third of all patients that walk through the door: I haven’t looked to see if that’s an accurate statement in terms of prevalence, but certainly they do expect to see hand OA in a significant proportion of people as they age. It’s not considered a ‘normal’ part of the aging process anymore, and we know it’s not just ‘wear and tear’ the way people used to say, but it does correlate with getting older. If all your other RD symptoms still appear to be well under control, then bog standard, stand-alone OA would be something to consider. If you have normal inflammatory markers even with active disease, the only way to say for sure what’s going on with your hands - and disease state, generally - would be to ultrasound the concerning joints. My understanding is that inflammation on ultrasound is definitive for active RD, and it can pick up inflammation in joints even with no outward signs. In England, GPs can usually refer for ultrasound. It’s how I finally, finally got diagnosed.

[mjrminor in reply to Hidden]

Thanks for your reply Charlie. I'm 48 years old, diagnosed at the age of 43 after a year of having pain symptoms. Secondary OA has crossed my mind, although I do have similar twisting in my left index finger, but no protruding knuckle bone.

I guess I'm going to have to wait for the hand xrays, and any ultrasound if the doctors feel further investigation is needed. Funnily enough it was an ultrasound that got me my original diagnosis, after the blood tests weren't showing anything.

[SunshineSmiles1 in reply to mjrminor]

I was about to come here to say exactly this. What an excellent and comprehensive response.

[MuppetBaby]

I had this a few months back, index finger tucking under middle finger and twisting in slightly. I was told it was because my fingers were swollen and arthritis active. I was told it should settle with better control which it has. Hope this helps I guess it’s different to everyone but if you have been getting increasing pain definitely worth highlighting.

[mjrminor in reply to MuppetBaby]

Thanks Karen. So did they make a change to your medication to get things under control?

[MuppetBaby in reply to mjrminor]

Yes I was awaiting starting Baricitinib as on Pred, Hydroxychloroquine and Sulfasalazine having stopping Abatacept about 5 months prior. Hospital were a bit slow in getting approval etc

[mjrminor in reply to MuppetBaby]

I'm glad the Baricitinib is working for you, that's great. I'm just on Hydroxychloroquine and Sulfasalazine, and have been for the past four years after unsuccessfully trying methotrexate then leflunomide.

[SpaghettiIsGood]

this kind of damage should not be happening if you're in clinical remission. Like another poster here said, will you be treated for active arthritis since you're now developing symptoms?

[mjrminor in reply to SpaghettiIsGood]

I hope they'll do something about it - the xrays are happening on the 12th, so I'll have to wait until the results are in.

[smilelines]

Just not sure if you are in a clinical remission if your hands are hurting as well as your wrists. Have they been sorer more recently?

[mjrminor in reply to smilelines]

They have. But after several months off from work due to another diagnosis, I went back part time and am working at a computer a few mornings a week. I'd put the extra pain down to that until I noticed the change in my knuckle bone.

[smilelines in reply to mjrminor]

😀I have to say you have very nice young looking hands. It will be interesting to see what the X-rays show.😀