Swollen hand/arm caused by flare?

[gifford7]

My right hand[impaired by GCA stroke] has been swollen the last 3 weeks as I tapered down to 7mg prednisone [recently dropping 1mg per 2 weeks]. I saw my neuro opthalmologist yesterday. He prescribed a deep venous thrombosis test which showed I don't have a blood clot. I asked him if this might be a flare and he said he didn't want to increase my steroid dose without my rheumy's approval. I have an appt with my rheumy next tues when he returns from vacation. Plan to get my CRP ESR tested today. Then maybe go up to 10mg to see if that stops the hand swelling. I want my hand swelling fixed ASAP as I have a new hand therapist visit mon. Comments? I did previously have a flare at 11mg and then went back up to 20mg. That time the CRP ESR jumped up.

[PMRpro Ambassador]

Sounds like a plan to me...

[gifford7 in reply to PMRpro]

This am had the blood test and increased prednisone from 7gm to 10gm. Results in normal range; CRP<2.9mg/L, ESR 6mm/hr. [my previous flare at 11 mg had CRP=31, ESR=35]. So if this is a flare its a different type of flare where CRP ESR stay normal. I plan to stay at 10mg pred at least 1 more day to see if any improvement in hand/arm swelling.

If its not a flare I need to find out what is causing the swelling. I did check blood pressure in both arms twice yesterday at the clinic and its within 1 point of each other. I will see my rheumy in 5 days on his return from vacation tues. In the meantime ???

[PMRpro Ambassador in reply to gifford7]

I would be inclined to think it could be something else - but still inflammatory if the pred has an effect. Has it improved at all?

The hand therapist is likely to be able to advise too.

[gifford7 in reply to PMRpro]

I don't think the higher dose of pred is helping. It may be something else like Carpal Tunnel syndrome. If no improvement in 48hr, back to 7mg pred and consult GP etc.

[gifford7 in reply to gifford7]

I now think the higher dose of pred, 10mg, is helping a bit so plan to stay on it til i see my rheumy in 4.5 days aug 7. Will also see my GP later the same day. I saw my hand therapist PT yesterday, who made the 2 hand splints to hold my fingers straight, for a tuneup. He said I don't have carpal tunnel syndrome and review for possible drug interaction. I'm on metaprolol, losartan, atorvastatin; don't see any related side effects. So back to the possibility its a flare unrelated to CRP ESR. The PT explained how to monitor the status of the hand swelling; find a 2 or 4 cup measuring cup; fill with water; dip my hand in and catch and measure the amount that spills out. I see my stroke therapist OT on mon aug 6. AND GO TO THE FOLKDANCE TOMORROW NITE TO REVIEW THE FOLKDANCES I LEARNED ATTENDING STOCKTON FOLK DANCE CAMP LAST WEEK; SCOTTISH COUNTRY DANCE, NEW ENGLAND CONTRAS & SQUARES, SWEDISH TURNING DANCES, MACEDONIAN LINE DANCES, ETC.

[gifford7 in reply to PMRpro]

Have been on the higher dose of prednisone, 10mg, for a week; the hand swelling is mostly gone but fingers are still swollen. Saw the rheumy yesterday and he pondered over various theories while reviewing the stroke report details. I mentioned the possibility of "limb claudication" but he said its not that. He mentioned something about subclavian arteries; and the possibility of "RS3PE".

He checked my pulse in both wrists is good and said vascular system is strong.

He said continue on 10mg pred since it seems to be working and wait for the rest of the swelling to stop before attempting tapering to 9mg. I do have arrhythmia and see my cardiologist later this month.

Some links:

Giant cell arteritis presenting with arm claudication

academic.oup.com/ageing/art...

gmjournal.co.uk/rs3pe-syndrome

"RS3PE is a type of benign seronegative polyarthritis that affects older people and is characterised by sudden onset of oedema and swelling of the dorsum of the hands with symmetrical polysynovitis involving wrists, metacarpophalangeal, interphalangeal, tarsal and metatarsophalangeal joints, tenosynovitis of the flexors and extensors of the hands, morning stiffness with negative rheumatoid and anti-nuclear antibody tests and rapid response to low dose corticosteroids.1-3"

[gifford7 in reply to gifford7]

Have been on 10mg pred and fingers still swollen, and curling; tapered to 9mg; wear a finger extension splint at nite to hold fingers straight. Found this comment at update.com on PMR.

"An unusual manifestation of distal involvement is the puffy edematous hand syndrome, or remitting symmetrical synovitis with peripheral edema (RS3PE) syndrome (picture 2). In this presentation, distal symptoms and signs can appear explosively and abruptly and often dominate the clinical situation. (See 'Differential diagnosis' below.)" Link

UPDATE.COM/CONTENTS/CLINICAL-MANIFESTATIONS PMR

uptodate.com/contents/clini...

I have not been diagnosed with PMR, only GCA. See my rheumy sep 11. May seek an appt with a hand surgeon at the local hand clinic. The symptoms seem to resemble Dupuytrens contracture, another Viking disease.

[gifford7 in reply to gifford7]

I saw my rheumy yesterday [sep 4]. He agreed the swollen hand responds to steroids but instead of increasing prednisone to 15-20mg, he recommended local treatment with steroid shot to hand or watchful waiting; i chose the latter. The goal to get my prednisone down to 5mg, tapering 1mg/4 weeks. [am prediabetic and have bleeding bruises at times]. The hand also was functionally impaired by the GCA stroke and has contracture; these treated with physical therapy and wearing a finger extension splint at nite. [not dupuytrens]

[Telian]

You've got a lot going on gifford. I hope you get some answers soon.

[Janstr]

I have had similar swelling in my right foot for several months. My GP thought it might be PMR related & sent me back to the Rheumotologist. Like you my CRP & ESR are normal, but were raised during an earlier flare. The Rheumotolgist suggested it might be a Rheumatoid Arthritis & prescibed methotrexate, which I have decided not to take (at the moment anyway), as the swelling is gradually reducing. I do put voltaren gel on it(GPs suggestion) & at the moment am not eating nightshade family veges, fruit or uncooked veges as it was suggested to me that these are inflammatory. I am interested to know what your rheumatologist has to say.

[gifford7 in reply to Janstr]

I have an ulnar deviation of the stroke impaired hand [hand tilts out] partially corrected with hand therapy. It can be caused by RA or OA among other things. Also have knobs on nuckles and previosly told I have OA. Have asked the rheumy if I might have RA and he said no. I think there is a blood test for RA factor. Will post the rheumy's diagnosis of swollen hand/arm. I have increased the fruits and veges in my diet at the lower doses of pred, to keep my system moving; also on a low carb diet due to prediabetes. H1c=6.5% no metaformin.

[Janstr in reply to gifford7]

The blood tests for RA can be negative for some people with RA