New joint/tendon/ligament pain

[Clash]

C was at PT yesterday, he was in-clinic being evaluated after 4 weeks of swimming. He is going to do another month of swimming and add a day of PT in clinic each week.

So after PT he came home did some homework then headed to work. He called an hour later and said he was headed home that his wrist/hand was swollen and very painful.

When he got home the swelling was from base of thumb to knuckle of first finger, the swelling wasn't bad, it was slightly red and his skin in that area had a shiny appearance.

The swelling/redness/shininess is gone but pain remains. Rheumatologist was closed but we got into GP, he said there was definitely inflammation but wasn't sure if it was from injury, repetitive use at work or enthesitis with spondylitis at this point. Since no NSAIDs he is on a pred pack for a week, if it is still an issue then he would want us to see rheumatologist and do some testing.

I found one paper that showed common sites of enthesitis due to SpA on body diagram that included the area that encompasses C's area that was swollen and hurts. Here is a link to the paper if it will post. The pic is half way down and is a skeletal diagram.


http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2095313/

His pain is located from the lower dot at the base of the thumb to the higher dot on the same hand.

So I guess a waiting game for now. Anybody have any opinions to help me keep this damn bubble intact?

 

[my little penguin]

Bubble- DS had thumb hand swelling once - no issue
Only when it occurs multiple times over a prolonged period is it an issue.
That said I would still call Rheumo and leave a message with the on call doc letting them know about the swelling - email pic and the pred he was taking .
Additionally call the gi since even pred packs can cause Gi issues if they are too short etc...

 

[Farmwife]

Sorry, Grace has the same swelling. I've never seen something so odd. I always thought it would be the whole hand or at least the whole finger. Her swelling can last an hour or days. I just never know. The rheumatologist said if it last more than 48 hours that she will have to be put on prednisone burst.

I hope it's better soon.

 

[Clash]

Yeah the GP was sending the info on to rheumy. Rheumy is away this week so PA may have gotten it this after noon. GP was also calling GI to let him know about the visit and that a pred pack was started.

I thought I'd call rheumatologist on Monday and see about an appt so she can see first hand. I plan on calling GI Monday morning to make sure GP sent all the info.

 

[Maya142]

There's a good bit about enthesitis in the hands in this article :http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2095313/

You can always hope it was an injury to keep the bubble intact...
I agree with MLP definitely let the rheumatologist know.
Fwiw methotrexate is supposed work well for small joints in the hand, so perhaps he just needs a higher dose or more time on the shots for it to kick in?

 

[Maya142]

Whoops just sent you the same article you posted (your link wouldn't work for me!). Sorry!

 

[Maya142]

Also pred (or medrol) dose packs don't help my girls very much. Just a couple days on each dose doesn't seem to help.
My older daughter had a steroid shot in her elbow once which helped immediately, and her elbow has never bothered her much after that.

 

[Clash]

C is at .08 of mtx, I thought rheumatologist said that was equivalent of .25 mg oral, does it go higher? Also, that is why C thinks it is physical because it happened day of mtx injection, he now thinks mtx is a cure allsince it took his lower back pain away! Haha plus, he is adament it is not due to arthritis, I know it is just denial on his part because he just started the job. I mean he has never had this before so how could he possibly know it isn't related to SpA? He has had joint pain at the wrist during CD flares before no swelling, redness etc and different location which to him proves it isn't arthritis...ughhh teenagers!

 

[Maya142]

I think 1ml is 25mg, which is as high as M went (at 90 pounds). My older daughter (110lbs) is also on 1ml. I've heard of people going up 30mg or so.
It's possible that the Remicade was keeping the SpA under control and now that he's off it, the mtx isn't enough by itself.
But I hope C is right and it was just an injury!

 

[Clash]

I'd like to hope C is right as well but the timing seems ominous with stopping remicade. Quick question though, there isn't always or generally swelling with IBD associated SpA is there, I thought that was the psoriatic type.

I guess one good think is the rheumatologist had sent an order for GP to do lab work so he had that done as well today.

 

[Maya142]

There can be swelling with any type of SpA I believe. M has had very swollen knees, swollen ankles, a warm and red lower back etc. My older daughter has had swelling in her knee, ankles, heels, elbow.
They've never had swelling in their hands and that is more common in psoriatic arthrits (but can happen with AS, it's just rarer). They have had stiff and painful hands though.

 

[Clash]

Thanks Maya142, I'm going to reread through the link we both posted. I have done as much in depth research with the SpA as I did with CD in the beginning. I think it is the denial phase but I'm coming around.

 

[Tesscorm]

Maybe a silly question (but working towards saving that bubble) - is there no way he could have injured it??

 

[Clash]

He doesn't recall doing anything to injure it. The only therapy he did with his hands/wrists fingers had to do with a rope thrown over a bar that was over his head. He grabbed an end with each hands and did see saw pulls to stretch. There were no weights or anything more than a light pull to stretch. But, the GP said he would be hard pressed to say it was more than some physical injury due to the swelling/pain occurring 4 hours after pt.

My Hubby thinks tendonitis since his new job requires a repetive movement of his hands for most of the on the clock time.

I don't know what to think, maybe we will know more after starting the pred. I'll take a physical injury over a flare of inflammation due to the SpA.

 

[DustyKat]

The rope exercise does involve a gripping action though and that would fit with the area involved. Does he use that action at work? If so the exercise coupled with work may have aggravated the problem??

Fingers crossed it is the lesser of two evils! :ghug:

Dusty. xxx

 

[Clash]

Dusty he does use that action at work. That is why the hubby keeps saying tendonitis. He feels since C has been this active the addition of pt and repetitive action at work has caused the issue. That is what I'm hoping for as well!

 

[Catherine]

It could be a swimmimg injury?

 

[Clash]

Maybe but not likely since he uses a kick board and not a lot of motion with his hands, something about building up his core and legs?

 

[DustyKat]

^^^^ Another grip action to add. :ghug:

 

[Clash]

I hope that is it. He went to work today. He says it hurts less the more he usues which sounds more arthritic than injury to me but at this point I think I just have to take his lead. He was really worried about the absences from work since he just started and had another day off but went back.

I'll grill him when he gets home of course!

 

[Tesscorm]

My finger was pushed back pretty badly a couple months back and a fair bit of my hand was hurting. It wasn't red but swollen and a bit bruised. I also found large (relative to a finger, ie opening/closing hand, stretching fingers wide, etc) movement helped lessen the pain considerably. After resting, ie mornings, it was very stiff and sore. However, while large movement helped, I found small, repetitive movement (on keyboard) wud make the pain worse. I also started noticing I was hvg sharp waves of pain in my lower arm - not the wrist or elbow joints but all along my arm btwn the joints - it didn't seem connected to the finger as they hurt independently but, thru physio, I've now found out it is connected as the muscles/tendons are connected. so perhaps, even if it's not 'obviously' due to his activities, it still may be?? :ghug:

 

[Catherine]

I am still going for swimming injury. DD developed a tiny bruise and slight swelling at join between two fingers. She didn't know what she had done hurt herself.

Are talking to the coach end up deciding it was caused by hitting the pool rope or the pool end.

 

[CarolinAlaska]

Sorry to hear it. Did it ever get resolved as to what caused it? Did it go away?

 

[Clash]

Yes, in fact it resolved itself by Saturday, before pred was taken. All docs updated Monday and both wanted to wait and keep an eye on. I've got to call about blood work. Since rheumatologist order was sent to GP it won't be on the patient portal.

 

[Tesscorm]

Glad to hear it's gotten better!!