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Regarding swollen/ altered knuckles plus an observation about folic intake

My knuckles on my right hand are permanently raised - not swollen as such perhaps - just the hard bony joints feel as if they are much bigger (like larger mountains!) on my right hand than my left and both hands are always tight - especially in the morning when I have to run them under hot water for a minute or two to get them bending and can never fully clench.

When I've looked online to see what people's swollen knuckles look like some aren't that different to mine but the swelling seems to make them disappear more whereas mine seem much more prominent than they used to be. If I measure mine with my forefinger and thumb on either side of my palm and knuckle then I find the knuckles on forefinger and middle finger are much thicker than those on the left hand. Is this just wear and tear because I'm right handed or might it be because some damage has already occurred? Neither hands hurt anymore but both hands have flashes of deep throb like toothache sometimes and both ache in the night. I had x-rays taken of my hands 18 months ago and they were fine but wonder if these changes are just ageing or whether it's RA that's making them feel as if they have been miss-aligned or bolted together badly - as if the various components just don't fit properly any more somehow?

Also wanted to add as a follow on to the folic question re my prescription review - I moved back down to one a week last week to see if the higher dose was making any difference now I'm on injectable MTX. 2 days after injecting I found I had two funny pimple-blisters on my face - one like a spot on my nostril and one on my cheek. Neither turned into proper spots and both were exactly the same as I used to get a few days after taking MTX orally, when on the lower dose of folic. I will keep the experiment going for a few weeks until I see my GP for bloods on 7th Jan and see if this is just a coincidence. Do others get these hard raised pimple-like blemishes on their face after taking MTX I wonder?

9 Replies

In answer to your question, the knuckles in both my hands swollen and the space between my knuckles looks full of fluid. It never goes away. I do have lymphoedema in my left arm and hand from previous surgery. I have taken to wearing compression gloves on both hands and this has helped (also gets me out of the washing up).

I have had what looks like little blood blisters that eventually go away without treatment. not had any recently tho.

I had hand X rays 9 months ago but nothing recently.

Just collect a book from the library on use of your hands with RA. it suggest 2 handed lifting of objects eg plates etc Also not to lift with the top joints of your fingers, as this lessens the degree of pressure in the fingers.I had not thought of that but it does make sense; will post on the site any other tips I come across.

Best Wishes



Thanks Carole. My hands were so much worse this time last year but it's just that I feel as if my hands are being pulled in several directions and it's very gradual but it's uncomfortable too and they are starting to hurt a little when I do things with them too. Nothing like they were when I was diagnosed but I'm a bit concerned there's very gradual deformation taking place. I did have an OT come round when I was first diagnosed and she gave me lots of bits of useful kitchen and work equipment and a leaflet on hand care. I did follow it faithfully for a while but once the MTX started working and my hands stopped being intensely painful I kind of lapsed. Will have to get back on track now - and use the laptop a bit less for starters because they do seem to swell up in the evenings most of all and I'm sure that's because of all the typing I'm doing!

No these aren't blood spots they are like little, pink very raised hard blisters and there's usually only one or two at a time and mostly on my face or neck and they are almost gone by the time each weekly dose of MTX comes around. They went away for about six months but have come back this week so wondering if it's because of the drop in folic. Tilda x


I did get lots of little water blisters on my hands when I first started mtx but I take folic acid every day so maybe that's why I don't get them any more.


Thanks - maybe its just me! Tilda x


Not sure if this is the same thing, but since being on MTX my teenage spots seems to have come back with a vengeance - and I'll be 50 soon!!



As I've got older and have had RA for longer, the joints don't go back to their previous size any more after a flare up. I've got secondary osteoarthritis now so they are permanently enlarged with bony extra nobbles.


Yes that's really why I'm asking Old Timer because after the RA first revealed itself I found that within a week or two of having a steroid injection, as my the swelling in my hands reduced the pain changed and became less of a deep throb but more sore - and to my horror lots of what i now know to be secondary OA bony nobbles appeared in the top of each finger joint. And now I don't really know whether this ache in my hands is due to RA returning or OA worsening in them. But since its also my feet I'm inclined to think its more RA than OA. Tilda x


Hi TildaT the toothache like pain you describe is something I get in my joints (and limbs all over at times). I am nearly pain free all day usually but often when I get into bed the deep aches, often fleeting, remind me I have RA. The 'deep in bone' does the rounds of so many of my bones that like you I find it difficult to believe it is OA. However soreness is a thing that I associate with OA.


Hi Wooly - is your RA currently active do you know? I just wondered if aching joints are a sign of things worsening with ESR etc or whether its just a mix of RA and OA. I'm not yet 50 (not quite !) and feel a bit young still to be having widespread OA - only aware of it on my fingers. So just trying to get to the bottom of the deep aching in feet, hands and wrists at night - like neuralgia really. But Amitriptyline works pretty well I have to say so might just up my dose to 2 and see how I go. Thanks. Tilda xx


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