An arthritic at age 30??

September 22, 2005 2:25 PM

I'd like a little help diagnosing joint pain in my fingers.

(This is kinda long - sorry.)

The most obvious guess, to me anyways, is arthritis. I went to the doctor about this and he looked at my fingers and felt them for a moment and said "well you certainly don't look arthritic" and that was the end of it. (That makes him sound like a pretty crappy doctor but I went in for a couple of other issues. I wish I had pressed the issue a bit more in retrospect.)

In particular, it's the joints closest to my fingertips that hurt. I've read rheumatoid arthritis tends not to hit these particular joints. It's worse when I first wake up. It hurts to make a fist but goes away after a few minutes of moving my hands. Even if I take a brief nap in the afternoon my hands will hurt when I wake up then too. If I grab that joint and squeeze it, it hurts even now, though.

The joints aren't swolen or warm or anything.

Some background - I'm 30. BMI calculators put me safely in the "normal" range. Low blood pressure. Don't know about blood sugar level or anything like that, if it matters. I don't know of any health problems I have, except I have psoriasis, which apparently can cause its own unique variet of arthritis as well. I exercise daily and my diet is... well, not terrible.

Also, the pain sorta coincided with my taking up Brazilian Jiu-Jitsu, which was about three months ago. I go five days a week. BJJ generally leaves me sore and bruised all over, though we are not allowed to attack fingers, and what's going on with my fingers doesn't seem like normal soreness/minor injury to me. To defend against chokes and arm bars I will often hold on to my lapel or sleeve, so I do end up clenching my fists pretty tightly from time to time there. Though I wouldn't expect that to cause my fingers to ache only after I wake up.

Does anyone have any ideas? This doesn't seem consistent with any list of symptoms for any variety of arthritis I've read about.

posted by mragreeable to health (17 comments total)

maybe you're getting something like shin splints? finger splints, maybe?
posted by boo_radley at 2:47 PM on September 22, 2005

The Brazilian Jiu-Jitsu would be my #1 suspect, not arthritis. All those falls, grasping, manipulations, etc. are putting a new type of strain on your joints.

I'm taking both Aikido and Jeet Kune Do for the first time, and I'm sore in places I didn't even know I had. The joints of my fingers are particularly sore. I'd suggest icing your hands after your classes to see if it made any difference.
posted by letitrain at 3:21 PM on September 22, 2005

Do you wear hand wraps to do your ju jitsu? Sometimes when I wrap up too tightly when I box I get pains in the joints of my fingers.
posted by jamesonandwater at 3:31 PM on September 22, 2005

Have you not consulted your sensei about this? Surely if the onset coincided with your uptake of BJJ, the thing to do is stop the Jiu Jitsu for a week or two to see if that effects you. Five days a week is a very intensive training schedule for any martial art (including chess ; )), have you always been going that often?
Go see an osteopath and maybe a physio if you want to continue training regardless of whether taking time off improves things.
I do a fair amount of hand drumming (as well Shinseido Shorin Ryu style karate) so my hands take a fair amount of abuse. One exercise which some people find reduces pain in the finger joints is very easy to do:
take hold of the tip of one (straightish and relaxed) finger with the thumb and fore finger of the other hand and rotate it gently from side to side along the axis of the finger. Grip the finger with just enough force to exert a very slight pull on it. Do not jerk or tug the fingers. This should be executed in a calm way with regular breath, taking no less than 5 seconds per finger and repeated a couple of times going round the fingers. Don't do the thumb, it has a different joint structure and doesn't seem to benefit from this exercise. If it hurts at all, don't do it.
I hope your training can continue and that you can isolate the cause of the problem.

On preview: ice is a good idea. Two minutes on, two minutes off would probably do with one of those cool pad thingies you put in the freezer, it should be wrapped in a towel or something as the skin should not be in contact with it directly. The ice reduces swelling and encourages slower, strong regrowth of tissue (AFAIK). However, even if this reduces the pain I would still suggest a visit to the osteo or physio so that you can receive hands-on advice. I hope that wasn't too patronising! Sorry about the pun.
posted by asok at 3:38 PM on September 22, 2005

Have you had a cold (or similar symptoms) recently? A few years back, I had a minor cold, which was then followed by several months of arthritic pains in my joints. The doctor said it was postviral arthritis, and would go away in time. It did, but only after consuming heroic amounts of ibuprofen each day. It was unpleasant.

I am not a doctor; this may not be what you have ...
posted by scruss at 3:52 PM on September 22, 2005

Check your email, but what you are describing are classic signs of psoriatic arthritis.

I have it and your description is spot on how mine became known. It can be serious so don't let your doctor blow you off. If you are seeing a dermatologist for your psoriasis have them refer you to a rheumatologist.
posted by karmaville at 4:00 PM on September 22, 2005

For "osteopath" read "osteopath or hand specialist"
posted by asok at 4:01 PM on September 22, 2005

It's true that those are not joints normally affected by rheumatoid arthritis, but these autoimmune arthritises are actually can be more like syndromes and can encompass a pretty wide range of symptoms. To be safe (because if it is arthritis, you want to catch it early) you may want to go to a rheumatologist to get your rheumatoid factor checked and psoriatic arthritis looked into (family history is another clue on these). That having been said, some sort of tendonitis sounds more likely for you - tendonitis can resemble arthritis symptoms, with more swelling and pain in the morning and in different types of weather, etc. I've had both arthritis and tendonitis in my fingers, and one can sometimes feel like the other.
posted by walla at 4:39 PM on September 22, 2005

I fear karmaville may well have nailed it. The symptoms certainly are similar. Also, apparently it's common to develop nail-fungus-like symptoms with psoriatic arthritis. And oddly, I have this one toenail that was misbehaving that I forgot to mention to the doctor...

This image really accurately shows where the pain is in my hand.

I had mostly ignored the psoriasis connection because for the past couple of years the psoriasis had appeared to have magically cured itself. I haven't had any visible sympts for a while now.

I'll definitely push my doctor to refer me to someone who can make certain that is/isn't what I have. A google image search for "psoriatic arthritis" makes it clear this is a condition one ought not take chances with.

Thanks, all.
posted by mragreeable at 5:42 PM on September 22, 2005

Dear God. This really illustrates the worst of AskMefi Medical.

MrAgreeable, your symptoms could be all kinds of things and there is truly an excellent chance that it is a reaction to unusual stresses on your DIP joints (distal inter-phalangeal). It could be Psoriatic arthritis. Do you have psoriatic plaques? It could be a whole shitload of things, but typically the best that labs can do is offer support, not a diagnosis, since rheumatoid antibodies et al are non-specific and often falsely elevated.

A bit of advice - like it or not, if you have a serious concern and ask about it after a few other issues in a single appointment, it won't get the attention it deserves. For your sake, and out of respect for the doc's time, asking why your DIP joints hurt at the end of a visit is not a good idea. That issue is an entire visit in itself and more.

Go back to your doctor. Ask for a rheum consult if you want.
posted by docpops at 9:22 PM on September 22, 2005

OK, sorry. I did not see your comment initially that you had psoriasis. My apologies. So yes, more than ever, go back and speak with your doc. Psoriatic arthritis is usually a challenge to diagnose until someone thinks to investigate it.

Your personal info suggests you are in Va Beach, so there should be good rheum docs near you, possibly through EVMS.

Good luck.
posted by docpops at 9:36 PM on September 22, 2005

For what it's worth, this doesn't sound like psoriatic arthritis to me. Also for what it's worth, I suffer from psoriatic arthritis - a mild case - and it's more than just fingertip pain. There are skin issues, physical stigmata, numerous other joints involved, family history, etc.

What you have sounds like joint inflammation brought on by overuse. Morning stiffness in the distal interphalagneal joint is damn near pathognomonic for this. But you should let a doc investigate it. The internet is not the proper place to get it dealt with.

Also, docpops, take it easy, will you? Your negative attitude doesn't help anyone - except yourself; it probably makes you feel more important than you actually are.
posted by ikkyu2 at 10:41 PM on September 22, 2005

Ikkyu2,

The merits of medical questions in askme has been debated as nauseam, and I'm one of the biggest advocates of this space for these kinds of issues. You know from clinical practice as well as anyone the fear patients have when they see us. One day of contemplating a diagnosis that has been suggested by online research or a well-meaning friend can be pure agony.

My 'negative attitude' was borne out of respect for the fear that MrA was likely experiencing after reading karmavilles 'diagnosis'. It was all about the phrasing. If he had said, hey, I had psoriasis, and then at some point had similar symptoms, and it wound up being arthritis, that would have been different. As stated, it was an authoritative diagnosis made from the perspective of an N=1 controlled study.

It will likely be weeks or longer before MrA gets anywhere with this, and meanwhile he is likely imagining a future filled with progressively debilitating pain, when you and I both know that's not the most likely reason why he has these symptoms. I imagine every person that sees you with vertigo or short-term memory and concentration issues has been led to believe by a well-intentioned source that they have MS, because I certainly have.

"it probably makes you feel more important than you actually are."

That's unprofessional as hell. From what I have gleaned from your postings, I'm actually pretty surprised.
posted by docpops at 7:22 AM on September 23, 2005

I guess you've already had your best answer, but I was going to suggest finding out about hypermobility syndrome, which I have. It's painful joints but different to arthritis. www.hypermobility.org
posted by angryjellybean at 8:21 AM on September 23, 2005

Hey docpops.

I definiltey agree that jumping to the psoriatic arthritis conclusion would look like a case of looking for zebras instead of horses.

I called my doctor's office and asked that the doctor reconsider his "no artritis" decision, and they've rescheduled an appointment.

Some other symptoms that I find compelling are the fact that those particular knucles look bruised and that I'm fatigued a lot. Those both have appeared in symptom lists for PA. However, I run four of five miles a day and practice a really strenuous martial art, so there may well be a simpler explanation for fatigue. Likewise the bruised-looking knuckes.

But it's clearly not something I should ignore. My biggest goal with this post was to find out if it sounded like something routine or cause for another doctor's visit. If nothing else I've found a pretty convincing argument to take the symptoms seriously.

Thanks, everyone, for the concern.
posted by mragreeable at 11:10 AM on September 23, 2005

You run four or five miles a day, plus strenuous martial arts five days a week, starting three months ago? Um, you might just be exhausted. Of course it could be any number of things, but perhaps while waiting for the appointment you could take a week or two off. Maybe run a few miles every other day, but seriously, take some time off and see if the aches and pains go away. It sounds like a lot, rather suddenly. That's a recipe for weird pains all over.
posted by fionab at 11:20 AM on September 23, 2005

MrA,

Thanks for the update. Your doc can definitely make some headway for you with a sed rate and a few other screenings. You might ask for a B12 level, and if so be sure to get something called an MMA to further support or dismiss a diagnosis of deficiency. B12 def. won't likely cause the arthralgias, but it's a reversible and increasingly common thing in healthy people.

Good luck.
posted by docpops at 1:10 PM on September 23, 2005