Do I have RA?

Bones, joints and muscles
1

Hi

Thanks in advance for anyone who reads this, and can offer me some guidance - I'm really struggling this weekend and feeling very down about my current state. Nonetheless will try to be as factual as I can.

My current situation is that I'm really struggling with my hands. They are not in pain per se, but they are in a constant state of weakness and I really feel like it's getting worse. As I right this with my arthritis gloves on, I can feel the tingling around the base of my fingers and palms. If I was to stop and gently place my fingers opposite each other in a prayer position, they would shake against each other nervously until enough pressure is applied. Today I have resisted from the necessity (was previously a temptation) to stretch the joints and exercise the hands - I have a couple of exercisers for this, but I'm not sure if it's making them better or worse. This usually provides a sound show which is only matched by the cracking of my elbow and shoulder - another addition which has seems to intensified over the past six months. Whether this is linked in any way to the upper back pain I've had for the past half year, I don't know. But what started as a pull from tennis, and worsened by my own ergonomic disaster when writing reports for my job, has now manifested into a dull pain right in the centre of my back, inbetween the shoulder blades. I've seen the GP and physio about this - they suggest it's muscular, but to me it feels to be right on the spine, which is obviously a worry.

My hand situation is not helped by a number of other factors. Ever since I was diagnosed with a trigger finger 16 years ago, I've sported a nice little scar on my left hand from the resultant surgery. Unfortunately the scar has now manifested into a deformity which looks like two bumps, which in my attempts to remain positive have nicknamed Larry and Barry. The doctor thinks it's the start of Dupruyten's contracture, and I must confess the stretch on my skin is starting to make my hand look a lot older than it should. Aesthetically, this is not the only thing - I have a bump on the base of my left hand (upperside) directly opposite the surgery, my knuckles and finger joints seem to be a lot bonier than they were.

Not that my left hand is worse than my right. No, if anything I struggle with that one even worse. Part of the issue with that one is the tiredness I get in my right wrist, a result of an injury I sustained a few years ago. The doctor thinks I've probably got scar tissue around the wrist - certainly not great when you're right handed, and play tennis and golf. Or at least I did - haven't played either in quite a while now (tried playing golf the other week and struggled to lift or feel the club).

So as I type this - albeit ergonomically in a better position - I'm bothered greatly by my lack of current lack of dexterity, cold and tingling hands, and twitchy forearms. Last night was the worse night I've had for pins and needles, which I can get from even just cupping my hands at night. I have managed to type this with a few breaks, but absolutely dreading the new year, when I start a new job in my profession as a primary school teacher. I am fearful that I won't be able to do the marking and planning - it was hard enough making a sandwich for lunch. And I don't know what to do, except keep waiting for the referral to come through to see the hand specialist on the NHS - still pending, two weeks and counting from my previous consultation. I've read the info online, and got lost in confusion at the amount of things that could be causing my condition, or indeed what it might be. Any help in this regard would be greatly appreciated as I try to manage this problem in the meantime.

Thanks

2

My symptoms came on with pain in both wrists.  I have the feelings of weakness like you but not the tingling.  My blood work showed markers for RA and that along with swelling and pain resulted in the diagnoses.

Your tingling sounds like carpel tunnel to me.  Has any Dr. checked for this?

 

3

Deb makes a good point. It certainly sounds like carpal tunnel to me too. The wrist gets inflamed, swells and jams up the nerves resulting inweakness, tingling and pain. If it also jams the tendon, you get trigger finger. We RA sufferers get ganglions too - I've got a lovely one under my right wrist.

Unfortunately muscle loss is part of this too, especially in the hands. Joints get inflamed and so we naturally use them less and the muscle wastes away, resulting in thinner, weaker hands.

As for your back pain, it sounds like costachondritis (look it up :-) which is inflammation of the rib cage, where the ribs join the spine and/or breastbone. Do you also get stabbing pains into your chest/breast? Does it hurt to take a deep breath?

I've had both thse conditions and this is what helped me;

Hands - get a wrist splint, not a bandage, an actual spint. A good pharmacy should have them. Wear them at night. This is when carpal tunnel is worst and it rests your wrists when you're not using them anyway.

Back - get a theraputic massage once a week. Your muscles will be very tight because of the pain and that makes the situation worse. Lie down as often as you can - that makes a big difference. And this sounds mad but it works - wear clothes with pockets you can put your hands in. It takes the weight off your shoulders.

Finally you need to get to your rheumatologist - sounds like your RA is not under control and you need your meds looked at.

4

The classic symptoms for RA are stiff, swollen tender joints which begins in various different places for people but mostly hands, shoulders, knees, feet. So I can see why you re puzzled as to what your diagnosis maybe. Has your gp ever ordered blood tests to look at this possibility?

i was given hand exercises to do- opening / stretching and closing, making an ' o' shape with thumb and each finger. It s important for keeping movement in joints.

Have you now got a 'mouse' where you can put your hand sideways on it? Conventional ones put a lot of strain on the hand. I think looking up correct  posture and position for using a keyboard may help you as you wait for your appointment and as you start your new job.Do back exercises if physio has given you any. Even if this does end up as an RA diagnosis exercise( but not joint strain) is completely appropriate.

but as others have said, you ve mentioned symptoms which seem to more likely carpal tunnel or other things. 

Hope you get some help at your next appointment

 

5

Lots of info here, so I'll just add this:

If it is carpel tunnel, then you might be well served, not just with the vital splint, but a mousepad with a resting pad, if you don't have one already.  This kept me from getting a repeat.

I wore a bandage-cum-split, all in one, that hooked into the thumb, wrapped stifly around and was joined with velcro. Very easy to remove and put back on.

If it is not carpel tunnel syndrome then consider the tingling, pins and needles thing as peripheral neuropathy. Just one of many possibilities.

The bumps after surgery sound familiar. I had stitches in a finger as a child and the bumps are still there. I like the idea, but I never thought to name them. Perhaps that gives them too much importance for me. (Like not naming feral cats in case you get too atattached!)  But I admit they've never bothered me except for a small extra sensitivty around the scar.

Lots for you to deal with this Christmas, so I wish you all the best...

 

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Thanks everyone for your help and empathy. Yesterday was a tough day - I've been trying to be as positive as possible but had got to the point this weekend of saying, "what's going on here? I'm 32, healthy, active, and about to start a new, important job...and yet I can't make a sandwich properly!"

Yet, I realise that there are millions worse off than me, so have been reluctant to express my discomfort - so thanks again for your help, as I didn't know where else to go yesterday (hence why I signed up yesterday).

Feeling a bit more positive today and coming to the realisation that this problem is not going to solve itself over night. I've read all your advice twice over and it's motivated me to start taking steps to self-manage this issue whilst I wait for my referral to the hand specialist/rheumatologist & physiotherapist. I've mentioned some of these ways in my replies to you individually and would appreciate your thoughts if you could spare any more of your time.

7

At my last consultation two weeks ago, the GP didn't do any checks. She has referred me though to another department so I assume that they'll do stuff like that whenever my appointment will be. I chased them up last week but it was still pending. I have no idea how long it takes.

I think my grandma had rheumatism before she died, and my uncle doesn't have the best hands either. It's these pointers which make me think it's RA, although there's so many different hand conditions it's obviously very hard for me to self-diagnose. Apart from the left overs from my trigger finger surgery, there's no obvious deformity as of yet except for a couple of ganglions - one next to the knuckle, and one on the top side of my right hand.

8

Thanks for the information Gail.

The back pain is an interesting one. I remember it starting as a strain from repetitive serving at tennis - oh how I regret playing that particular match. At the time I was writing reports for my work and in my desperation to finish took absolutely no notice of my posture. I vividly remember aggravating it whilst on the laptop, and in my naivity taking some ibuprofen to make it go away. Again, massive regrets for bringing it on myself.

It got worse over the summer so I managed to get a referral to the physio, which I'm in the process of doing again now. I'm also using a roller but just ordered a better one to target the knots (as you say, the muscles are extremely tight).

I also had a chest x-ray which came back clear. The reason they sent me for this because an associated issue I was having was intermittent stabs of pain on my left side, at the bottom of the ribcage, which to me felt like a stitch or tightness of the heart. I still get it every now and again - sometimes when running - and really have to focus on my breathing to alleviate it. I did a big race back in October and the back pain really kicked in after ten miles - stabbing pain like you mentioned, but bang in the centre of the back (maybe a touch to the right). It also gives me neck pain - mainly on the right side.

I looked up this costachondritis - it sounds like similar symptoms for sure. Do my symptoms sound similar to you?

Last night I slept with some ankle guards over my wrists i.e. the wrong way round. I'll keep doing this for a few nights to see if it stops the pins and needles.

I haven't got any meds at the moment as haven't had my referral. I've started to use ibuprofen gel to try and stop the tingling/weakness. Is there anything else you could recommend whilst I'm in limbo? I usually take cod liver oil, glucosamine and vitamin C but try to avoid paracetemol and ibuprofren in general.

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Hi Gail...i've replied to this but it's awaiting moderation! (I included a link to this hand website I got a tip off....whoops) Hope it appears shortly - thanks for your info.

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Thanks Rowbirdie. My shoulders are very stiff most days but I don't know if this is associated to the back pain I've got. I've made a point in the last couple of weeks of getting the yoga mat out and doing some cat stretches etc - I'm still pretty flexible and like to push myself - do you think I need to take it easier in this regard?

I've dumped the hand exerciser/grip exerciser in the last couple of days and gone back to gripping a ball/doing the ones you've said. I read somewhere that the hand exerciser might aggravate the problems?

Like you say, really confused about what my diagnosis might be - feet click too and can feel tired, but I do do quite a bit of running (approx. 10 miles a week).

As mentioned on a previous reply to Gail, I've started to do some rolling on my back to try and release the tightness. Was thinking of taping some tennis balls together too to massage the palms and soles of feet.

11

Thank you Light. Yep there's a lot to deal with indeed, but feeling today like I want to take on the problems.

Thank you for the tips re mouse pads etc - I have bought some new arthritis gloves this morning which look familiar to the description you have given. I have found that fingerless gloves help so looking forward to those arriving. Will look into the pads that you and Rowbirdie have mentioned.

I'm a bit concerned about the bumps. They have significantly got worse in the last year to the extent that they are now pulling on the skin of my fourth finger. The only reason I named and coloured them in (as a pumpkin and apple!) was not to freak out my nephew! Other people do get freaked out by the deformity, which I can understand.

I'm more concerned that you might be right re peripheral neuropathy. The doctor and physio on previous consultations seem to thinkthat the injury I did to my back is muscular, but a few things have caught my attention to suggest otherwise:

- on a few occasions in the last few months, when I've turned my neck quickly (inadvertently), I've got that 'trapped nerve' feeling/shiver

- my hands are a lot worse after alcohol and caffeine. I've cut the last one out of my diet almost completely recently, although it's proving more difficult with the former, being Christmas and all. But I can say for a fact that the last few times I've 'gone out', my hands have been a lot worse the next day. I know that diabetes is also a cause of PN but all my most recent blood tests haven't shown up high blood sugar, and my feet don't seem to be too bad which I know is a normal side effect.

12

Could the 'new important job' have anything to do with it? You mentioned it twice.

Nerves, perhaps, inducing some physical symptoms...? (symptoms of the nervous system!?)

I know this may sound far-fetched but it does happen more than we like to admit.

13

Hi Light.

​I understand what you're saying but don't think it's a cause. It's important from the context that I'm taking on a class halfway through the year, and I'm obviously very aware of the amount of marking and analysis I'll have to do. But I can honestly say I'm comfortable with the challenge per se, and only concerned about how my underlying symptoms will affect my performance - but none more so than how it affects my every day tasks, lifestyle, ability to make a sandwich, etc.

​I'm still chasing up my referral to the musculoskeletal clinic and don't think it will be coming anytime soon. I think I'm going to have to try my best to self-manage in the meantime, although I think I will book into a physio to assess the dull ache emanating from the centre of my back. In many ways I'm hopeful that this is the route of my issues and that something is trapping nerves through the shoulders and down to the hands etc. I know it's easy to be hypothetical in these situations but nonetheless...

14

An update:

​- Still got the shakes and an abnormal amount of clicking. However...

​- Been using a modified splint at night and compression sleeves. I must say that this has helped the state of my hands when I first wake up and stopped the pins and needles at night.

​- Muscle tightness in back still prevalent. I've bought a roller to try and assist.

​- Left shoulder and elbow seem to be a focus of the clicking. When i rotate the arm when stretched out both make a huge crack. I'm wondering if this is all related.

​- Hands still become very tired as the day wears on. Laptop use not helpful although really thinking about my posture and ergonomics. Have bought some new gloves, a wrist pad and an ergonomic mouse to help.

​- Going away this weekend where alcohol consumption will be unavoidable. Going to take my gloves and sleeves, hand exerciser and ibuprofen gel because I'm weary that the shaking and weakness in hands will be ten times worse. Should be interesting to see how I can manage it. (Water and exercise of course will be part of that process)

15

We're rooting for you Jimbo. Have a great weekend inspite of it all!

16

Hi Jimbo - hope your hands weren't too shaky to lift the glass. I hate it when that happens :-)

I have some extra info for you.

Stress, including stress we handle well mentally can still effect us physically. When we get stressed we produce something called cytokines which are PRO inflammation. I used to teach too - I ran a project for excluded 15-16 year olds and kids coming out of juvenile detention centers (teenage prison). Loved it and handled the stress just fine. The body didn't.

Don't underestimate the value of rest. If you do have RA you will not be able to push yourself as you once did. RA severely punishes heroes. You need to listen to your body and stop BEFORE things start to hurt. Its difficult to do because the natural tendency is to keep going, especially for sporty types who 'push through the pain.' Typically, it takes about 3 days for an overworked joint to flare. We all learn to ask ourselves "So what was I doing 3 days ago?" From what you have said, you seem to be asking a sick body to keep doing what it used to do when it was well. With RA, you can't drive your body like a slave, you have to treat it like it's your dear old granny.

NSAIDS are fine until you start on the meds. They don't combine well and can really upset your liver and kidneys. Panadol every four hours is a better option.

Alcohol - I bet your joints will give you grief after the weekend! Alcohol is a dehydrator. Dryer joints = more friction = more inflammation = ouch!

 

17

Thanks Gail

just listening in at 2.30 am with a suddenly painful wrist and found that info very helpful.

yes I m someone too who managed stress well before becoming ill- would have said I was hardly ever stressed, but now have to listen to my body when it reacts over small things! And agree rest is helpful.

18

Gail, I like what you say to Jimbo about "you have to treat [your body] like it's your dear old granny."

You do. Or like a small baby.

Either granny or baby, you don't bully them into doing what you think they should do becuse you understand their limitations. On the contrary, you treasure them, care for them and treat them with love and sensitivity.

And tht's the big lesson we RA folk have to learn. To treat our bodies with deep love and respect and follow its needs without guilt...

19

Thank you everyone once again for your help, advice and support. I really appreciate the opportunity to have been able to communicate about these issues and learn about the approach I need to take. All of your advice has been very helpful and at the very least given me some tools to self-manage my symptoms before I get a full diagnosis.

I had a fantastic weekend by the way, and although it was difficult to manage at times I kept pretty positive about it all. Feeling very shaky today but that was to be expected!

I did come back to some really good news, in that my referral letter has come through. I'm booked in for my initial assessment in four weeks time, so going to see the physio in the meantime to ensure i'm doing the right things in terms of exercises and stretches. Of course I will be starting the new job in the meantime so just going have to be very disciplined in looking after the body whilst it's going through these problems...or changes even. I know this is obviously down to me to look after myself and adapt to these changes - I'm certainly willing to make the sacrifices if it means I can have a degree of dexterity back.

Anyway I will keep posting on here as and when and I'm sure I'll be an active member of the community whether it be that I have CTS, RA or whatever else. In the meantime have a Merry Christmas everyone and happy new year! 

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Merry Christmas to you too!

Ans keep us posted as to how you make out in the new job.