Help me understand my arthritis
August 30, 2022 6:27 PM Subscribe
I've been having issues with many of the joints in my fingers for the last year or so. I've seen three doctors and a hand therapist, all of whom have said osteoarthritis, but explanations for the idiosyncrasies of what's going on are decidedly lacking - as is any guidance on what I should be doing.
I seem to have some symptoms that match osteoarthritis very well, such as pain and stiffness in particular joints after using vibrating tools like a jackhammer, and some that match much less well, such as extremely rapid onset pain and mobile pain (pain moving from joint to joint).
I think I've had pain for at a low level for quite a while, years perhaps, but didn't notice it properly until last year, when I had several weeks for jackhammer use that left me severely stiff and sore for weeks afterwards, almost entirely contained across the central fingers of each hand, with a right hand bias (I'm right handed).
That led me to my GP and then a hand therapist, who both said simple osteoarthritis, your joints are worn out, you need to think about changing what you do for work.
Ok, fairly simple, I thought, though demoralising, let's ditch using impact drivers and hammer drills and the like and see what happens. I also started taking glucosamine and MSM supplements, because I might as well.
I've found that the pain in the joints associated with that tool use has 90% cleared up, I assume mostly from the change in use that I've enforced. I am still working intensively with my hands but I've almost entirely stopped using vibrating tools. I can induce pain and stiffness in these middle of hand joints by giving them a hard day, which seems fairly easily explicable.
What I do have remaining though is almost random, mobile, pain, still joint associated, of variable severity. Right this minute, the second knuckle in my right hand little finger is minorly-moderately painful and has been for a week, with some adjacent knuckles occasionally joining in. Prior to that the last knuckle and finger pad on my left hand index finger was extremely painful, swollen and hot to touch for two weeks, no injury, with onset occuring over about two hours. Before that the first knuckle on my left hand little finger was painful and bruised for several weeks. No injuries are associated with these episodes (at least not significant ones - I work with my hands, they may have been bumped I suppose) and once they clear up it's like nothing happened.
I have only very minor other issues like this elsewhere - a stiff knee from a bad bike accident when I was 17 and clicky/sore big toes in the mornings.
I saw a (different) doctor for the episode with my index finger, who did a bunch of blood tests that ruled out rheumatoid-arthritis and gout but didn't give any actual answers.
What I've been led to believe about osteoarthritis is that it is associated with specific joints, often that have been used hard, and doesn't behave in such a random manner as I'm seeing. But I'm still told I have osteoarthritis and it feels like the hard to explain symptoms are mostly ignored. Am I wrong, is this all easily explained by osteoarthritis?
My hands have done a lot of work, over my whole life. I can understand my right middle finger, for example, being pretty clapped out. But my left little finger? Not so much.
I'd love to understand what's going on and what to do about it or how to manage it. Any leads or things to investigate would be welcome.
I seem to have some symptoms that match osteoarthritis very well, such as pain and stiffness in particular joints after using vibrating tools like a jackhammer, and some that match much less well, such as extremely rapid onset pain and mobile pain (pain moving from joint to joint).
I think I've had pain for at a low level for quite a while, years perhaps, but didn't notice it properly until last year, when I had several weeks for jackhammer use that left me severely stiff and sore for weeks afterwards, almost entirely contained across the central fingers of each hand, with a right hand bias (I'm right handed).
That led me to my GP and then a hand therapist, who both said simple osteoarthritis, your joints are worn out, you need to think about changing what you do for work.
Ok, fairly simple, I thought, though demoralising, let's ditch using impact drivers and hammer drills and the like and see what happens. I also started taking glucosamine and MSM supplements, because I might as well.
I've found that the pain in the joints associated with that tool use has 90% cleared up, I assume mostly from the change in use that I've enforced. I am still working intensively with my hands but I've almost entirely stopped using vibrating tools. I can induce pain and stiffness in these middle of hand joints by giving them a hard day, which seems fairly easily explicable.
What I do have remaining though is almost random, mobile, pain, still joint associated, of variable severity. Right this minute, the second knuckle in my right hand little finger is minorly-moderately painful and has been for a week, with some adjacent knuckles occasionally joining in. Prior to that the last knuckle and finger pad on my left hand index finger was extremely painful, swollen and hot to touch for two weeks, no injury, with onset occuring over about two hours. Before that the first knuckle on my left hand little finger was painful and bruised for several weeks. No injuries are associated with these episodes (at least not significant ones - I work with my hands, they may have been bumped I suppose) and once they clear up it's like nothing happened.
I have only very minor other issues like this elsewhere - a stiff knee from a bad bike accident when I was 17 and clicky/sore big toes in the mornings.
I saw a (different) doctor for the episode with my index finger, who did a bunch of blood tests that ruled out rheumatoid-arthritis and gout but didn't give any actual answers.
What I've been led to believe about osteoarthritis is that it is associated with specific joints, often that have been used hard, and doesn't behave in such a random manner as I'm seeing. But I'm still told I have osteoarthritis and it feels like the hard to explain symptoms are mostly ignored. Am I wrong, is this all easily explained by osteoarthritis?
My hands have done a lot of work, over my whole life. I can understand my right middle finger, for example, being pretty clapped out. But my left little finger? Not so much.
I'd love to understand what's going on and what to do about it or how to manage it. Any leads or things to investigate would be welcome.
Osteoarthritis is said to be primarily a degenerative process but certain symptoms are clearly influenced by inflammation. These happen to be things like the rapid onset and mobile pains. Also gelling (stiffness and pain in a joint that hasn't been used in a while, improving fairly rapidly after some use). For many people the other aspects of osteoarthritis (like your stiff knee and clicky toes) aren't the ones that really affect their quality of life. That's where methods of helping pain and inflammation come in handy.
The way I think of the anti-inflammatories is that certain ones work on signals that act as master switches (e.g. IL-1, COX, NF-κB). These work in many people and can help many conditions but because the medications that target them they have many effects, they are more likely to have side effects as well. On the other hand, a more selective anti-inflammatory may target a signal that is involved with some people's arthritis but not others. These agents will appear to have a lesser effect in trials because we don't choose osteoarthritis trial participants by inflammation type so the responders are mixed in with the nonresponders.
When trying to find something that works for you, you have the option of taking something like prednisone (will almost certainly take away your migratory pains at a severe cost in terms of side effects) or NSAIDs like ibuprofen (63.8% chance of improvement, generally considered safe enough to be over the counter, but some people will get ulcers, kidney injury or heart attack) for inflammation. You could also take opioids or acetaminophen to cover up pain without significantly affecting the inflammation. In my view, it's much more valuable to think in the long term and look for more benign options that may work well for you and have a narrower action with fewer long term risks.
Glucosamine has several proposed mechanisms of action, including helping the cells that maintain cartilage and acting as a nutrient for the production of joint fluid. It also seems to affect some of the inflammatory signals that occur in the joint. It's already in your body and I don't know of any side effects.
Hyaluronic acid is a polymer chain of glucosamines that probably is digested down to shorter chains before absorption. It too seems to have several proposed mechanisms of action based partly on chain length and location.
Curcumin (derived from turmeric) is a Jak-Stat inhibitor that can be difficult to absorb orally. Preparations with piperine or lecithin work much better than just plain turmeric.
Boron, fish oil, MSM and SAM-e also seem benign and seem to have potential to help with painful osteoarthritis. I don't know as much about the anti-inflammatory mechanisms involved.
These are some of the options you could try to see if they affect your symptoms. Usually you'd know in a month or two if something is helping. Don't keep taking something that doesn't give you benefit.
posted by Emmy Noether at 8:38 PM on August 30, 2022 [4 favorites]
The way I think of the anti-inflammatories is that certain ones work on signals that act as master switches (e.g. IL-1, COX, NF-κB). These work in many people and can help many conditions but because the medications that target them they have many effects, they are more likely to have side effects as well. On the other hand, a more selective anti-inflammatory may target a signal that is involved with some people's arthritis but not others. These agents will appear to have a lesser effect in trials because we don't choose osteoarthritis trial participants by inflammation type so the responders are mixed in with the nonresponders.
When trying to find something that works for you, you have the option of taking something like prednisone (will almost certainly take away your migratory pains at a severe cost in terms of side effects) or NSAIDs like ibuprofen (63.8% chance of improvement, generally considered safe enough to be over the counter, but some people will get ulcers, kidney injury or heart attack) for inflammation. You could also take opioids or acetaminophen to cover up pain without significantly affecting the inflammation. In my view, it's much more valuable to think in the long term and look for more benign options that may work well for you and have a narrower action with fewer long term risks.
Glucosamine has several proposed mechanisms of action, including helping the cells that maintain cartilage and acting as a nutrient for the production of joint fluid. It also seems to affect some of the inflammatory signals that occur in the joint. It's already in your body and I don't know of any side effects.
Hyaluronic acid is a polymer chain of glucosamines that probably is digested down to shorter chains before absorption. It too seems to have several proposed mechanisms of action based partly on chain length and location.
Curcumin (derived from turmeric) is a Jak-Stat inhibitor that can be difficult to absorb orally. Preparations with piperine or lecithin work much better than just plain turmeric.
Boron, fish oil, MSM and SAM-e also seem benign and seem to have potential to help with painful osteoarthritis. I don't know as much about the anti-inflammatory mechanisms involved.
These are some of the options you could try to see if they affect your symptoms. Usually you'd know in a month or two if something is helping. Don't keep taking something that doesn't give you benefit.
posted by Emmy Noether at 8:38 PM on August 30, 2022 [4 favorites]
Anecdote about osteoarthritis: We ran a study that enrolled people awaiting hip or knee replacement (the main reason for these operations is osteoarthritis), and participants either received 'usual care' or were encouraged to follow a Mediterranean (i.e., low-inflammatory) diet for the year prior to their surgery.
During telephone follow-ups, some participants mentioned that while following the low-inflammatory diet was not noticeable at first, if they went off the diet for a few days (Xmas, celebrations, family birthdays etc), they noticed immediately that their symptoms returned.
I have a similar anecdote from family members (over 65 years old) who shifted to a vegetable-heavy, near-vegetarian diet for a few months, and when they later went out for a meat-heavy dinner they noticed they were stiff and sore the next day.
posted by lulu68 at 9:22 PM on August 30, 2022 [1 favorite]
During telephone follow-ups, some participants mentioned that while following the low-inflammatory diet was not noticeable at first, if they went off the diet for a few days (Xmas, celebrations, family birthdays etc), they noticed immediately that their symptoms returned.
I have a similar anecdote from family members (over 65 years old) who shifted to a vegetable-heavy, near-vegetarian diet for a few months, and when they later went out for a meat-heavy dinner they noticed they were stiff and sore the next day.
posted by lulu68 at 9:22 PM on August 30, 2022 [1 favorite]
Prior to that the last knuckle and finger pad on my left hand index finger was extremely painful, swollen and hot to touch for two weeks, no injury, with onset occuring over about two hours.
I won’t argue that actually do have rheumatoid arthritis, but the quoted passage is clearly describing an immune system mediated response.
My guess is that you are experiencing an aftereffect of the injury to your index finger you asked about some years ago.
Development of a thick scar on a wound can sometimes be an indicator of a sequestered infection in a wound — I’ve had a number of surgeries which healed almost scar-free, but I had one from an incision for surgical repair of a severely broken ankle which bled extensively into the joint capsule, that developed a thick, ropy scar along the surgical incision. More than 15 years later I had a prescription for penicillin with clavulinic acid (which is an additive which defeats a certain common form of bacterial resistance to penicillin) and five or six ulcers broke out along the length of that scar. As those healed, the scar settled down into a thin white line and is now almost invisible.
I think it’s possible that bacteria or other antigens got into the joint capsule of your index finger after that initial injury, where they would be largely invisible to your immune system as are the internal tissues of the joint themselves, and that when you did all that jack hammer work, your immune system noticed those antigens and the joint tissues finally, and is now attacking your joints when they experience mild trauma which would normally lead to mild and transient soreness.
posted by jamjam at 10:11 PM on August 30, 2022 [1 favorite]
I won’t argue that actually do have rheumatoid arthritis, but the quoted passage is clearly describing an immune system mediated response.
My guess is that you are experiencing an aftereffect of the injury to your index finger you asked about some years ago.
Development of a thick scar on a wound can sometimes be an indicator of a sequestered infection in a wound — I’ve had a number of surgeries which healed almost scar-free, but I had one from an incision for surgical repair of a severely broken ankle which bled extensively into the joint capsule, that developed a thick, ropy scar along the surgical incision. More than 15 years later I had a prescription for penicillin with clavulinic acid (which is an additive which defeats a certain common form of bacterial resistance to penicillin) and five or six ulcers broke out along the length of that scar. As those healed, the scar settled down into a thin white line and is now almost invisible.
I think it’s possible that bacteria or other antigens got into the joint capsule of your index finger after that initial injury, where they would be largely invisible to your immune system as are the internal tissues of the joint themselves, and that when you did all that jack hammer work, your immune system noticed those antigens and the joint tissues finally, and is now attacking your joints when they experience mild trauma which would normally lead to mild and transient soreness.
posted by jamjam at 10:11 PM on August 30, 2022 [1 favorite]
Response by poster: Seeing as it has come up, that scar is still fairly chunky but hasn't been involved in any of this other than being painful (along with the whole area) when that finger was swollen. It is the biggest single scar on my hands but my hands have been cut open, mostly accidentally, to an extent that only other people who have done a lot of manual work will really get. (i.e., a hell of a lot, given 30 years of use, but not in a remarkable way.) I'd reckon it's possible that history has something to do with things but no doctor has remarked upon it despite the scars being evident.
posted by deadwax at 10:41 PM on August 30, 2022
posted by deadwax at 10:41 PM on August 30, 2022
Most doctors do a poor job with low level or chronic pain. I feel weird saying that! But it is a known feature of the western system that we do not do a great job with this sort of injury/issue. You may need to shop around a bit or look for doctors who specialize, and I've known folks who found great success with acupuncturists or Chinese medicine (didn't do jack for me). For me I tried probably half a dozen PTs until one who specializes in sports medicine [technically a chiro but you wouldn't know it from my sessions] turned out to be a miracle worker.
You may also want to try some of the things that folks with rheumatoid arthritis try, because there are many similar conditions that don't seem to show up on the tests or are at a lower level than the tests look for. A strict anti-inflammatory diet or Mediterranean diet is one such thing. No guarantees but it might go on your list to try.
posted by Lady Li at 12:21 AM on September 1, 2022
You may also want to try some of the things that folks with rheumatoid arthritis try, because there are many similar conditions that don't seem to show up on the tests or are at a lower level than the tests look for. A strict anti-inflammatory diet or Mediterranean diet is one such thing. No guarantees but it might go on your list to try.
posted by Lady Li at 12:21 AM on September 1, 2022
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posted by drpynchon at 8:34 PM on August 30, 2022