Neurological signs of RA?

Bones, joints and muscles
1

I'm really interested in knowing more about neurological signs in rheumatoid arthritis.

I have been getting joint pain in my fingers, wrists and toes, plus pins and needles in my hands and feet for a few months now - plus morning stiffness that ranges from mildly annoying to virtually disabling.

My doctor zoned in on the pins and needles, but scans have ruled out nerve entrapment in the spine.

He's now referring me to a rheumatologist. I have started to lose some function in one hand. I can't join the thumb and pinkie, or click my fingers, and gripping anything is exhausting. None of the usual signs you'd expect with carpal syndrome though, except what looks like slight thenar atrophy.

Meanwhile, my joint pains are persisting. My knuckles occasionally look a little red, but nothing really "angry". My big toes are the same and one has started to develop a bunion.

More recent symptoms include a burning sensation on the soles of my feet, sharp chest pain above the right breast when breathing in (this has happened twice but went away after about half an hour each time), pain in elbows and one shoulder, muscle spasm in the neck. On the plus side, the pins and needles are less frequent.

It's obviously troubling me because it's been going on for a while and because I'm losing hand function. But I just don't know whether a rheumatolgist is the right way to go. It seems like a lot of my symptoms are neurological. 

I can't find much reliable information about the link between these neurological symptoms and RA. Maybe actual RA patients who have neurological symptoms could shed some light? 

I don't want to have a load of expensive tests and referrals only for them to find nothing wrong.

My bloods were taken nearly three months ago, when my symptoms were quite new. RF was "20<", CRP was 4. The only abnormalities were slight anaemia and low creatinine (which I understand is okay except it can indicate muscle wastage).

Any advice or information welcome.

2

I have RA and your pains sound very similar. It s surprising how much pain at the joints you ve mentioned affect other parts of the arm , feeling almost as though muscles or nerves are affected, but they re not. The morning stiffness is classic RA  if it lasts for more than an half hour and the level of pain you are experiencing is typical, so it is surprising your blood tests don't show more . I would have thought it s worth having blood tests again and seeing a rheumatologist.

I personally haven't had pins and needles though, so it will be useful to see if anyone else has. Are you sure it s a bunion you have? I have 1 swollen toe joint which looks a bit like a bunion.

I read that the 3 typical signs of RA are Stiffness ( lasting more than half hour in the morning ) Swollen ( typically middle joints on fingers) Squeeze( that means some pain if you squeeze across hand or foot)  

i hope you get some helpful responses to your query.

3

Hi elbmow; I'm sorry that you are having problems, and yes, they would be worrying if you are having extra side effects....I think it's a Very good idea to see a Rhuematoligist, as they are very good at diagnosing Many disorders....they specialize in Pain, and it's causitive factors...the other would be a Neurologist, if nothing comes from this visit....you say that "no nerves pinching from spine", but what about from Shoulders....if in arms, I would think it would be coming from shoulder/s (brachial area)???   and as has been said, what Looks like a Bunion, could very possibly be as a result from Rhuematoid, having affected the joint in the toe, which once "settled", leaves a "knobbly" formation on the joint.....sorry that we can't give you more info, but will be interested in what the Rhuemy has to say....and in meantime, ask your GP to have All relevant tests performed before going to your appt, to save time.....good luck, and let us know what the results are.....will be thinking of you..............Bron

4

Interesting, I am having the same problems except mine in just in my arms from the shoulders down and it just started. I cannot find any good info on it either. I am getting carpel tunnel syndrome really bad and it seems to get worse every day. Shoulders burn like they are on fire and my whole right hand is numb. My doctor is away so his replacement ordered gabatentine and I have just now worked up to 3 pills a day. They can knock you for a loop but I am getting used to them. They do not take away the pain but I don't care on these pills. I am reading that RA and the medications used to treat it can cause nerve entrapment. I am in the process of setting up an EMP

5

Hi. Thanks for your reply.

I'm not sure it is a bunion but it looks like one. My pain started in my big toes. In fact, I was misdiagnosed with gout at first because one (not the 'bunion' one) swelled up.

I don't really pass the "Squeeze" test. Even when my knuckles are at their worst, only once has it caused additional pain to press them. 

I know I just need to wait to see the rheumatologist but it's frustrating when nothing seems to match up.

6

Hi. Thanks for your reply. Interesting info on the bunion.

7

Morning River;  no medication will really help "carpal tunnell", that I know of, as the ligamnets are "tightning" the nerve (pinching/squeezing the nerve).   Usually for full relief, this will require surgical intervention,...a minor procedue (if performed by a Good dr), and relatively easy recuperation time......just needing elevation and not using the affected wrist for a few weeks......good luck....Bron

8

It's coming on so fast it's scaring me. My right hand is almost numb and the fingers feel like they are drawing up. Heck this only started about a week ago. My left arm and hand is either having sympathy pains or it's affected too. At this rate I'll be disabled by next week. I called the dr today and had to leave a message. I will check back with them Mon.

 

9

Evening river; that doesn't sound like "carpal tunnel"...that takes months +...I think I'd be going to ED , if it's getting that bad sooo quickly....especially if you couldn't contact your own GP/Rhuemy....sorry Bron

10

Hi Elbmow.

Sorry you're going through all this. Sounds like quite a package!

It's not impossible that you have peripheral neuropathy as well as RA. I do. Sad to have to say this, but these auto-immune conditions tend to come in gangs.

The burning in the soles of your feet and the pins and needle =14pxare both symptoms of=14px PN. I have them both, though the pins and needles are mild and restricted to the soles of my feet along with the burning.

My soles burn most when the outside temperature rises beyond around 23 degrees (Celcius) or when I have done a lot of walking.... but I usually only really feel it when I'm lying down and my feet are up.

Sound familiar?

This is a PN thing and I've suffered it for years. I live in a hot climate a lot of the time, so it's especially disturbing when I'm trying to sleep, but I deal with it as best I can, mainly by soaking my feet in cold water before bed.

At my last visit to my UK rheumy, he suggested there are drugs to deal with it, but he never told me more and I didn't persue it because I'm alredy taking more drugs than I can handle.

As for RA.... well, one of the main markers of RA (usually) is its symmetry. What comes on one side gets mirrored on the other.

Another marker is how it reacts to your body movement... Serious pain and stiffness in the morning – sometimes excrutiating in the morning – but loosening up during the day. Stiffness when you get up from your chair and soon easing.

Its pain is restricted to the joints as far as I know, and sometimes moves around joint to joint, but is usually bilateral.

Your bunion...

Is your bunion a real bunion or could it be that your big toe is turning inward giving the appearance of a bunion? There's a difference... although, if one was turning inward, I would have expected both to.

The inward turning big toe, though on one foot only, still could be a reaction to RA, but as its on one foot only it might be something quite different, like gout.

How painful is that joint?

What is important at this stage is to have your joints x-rayed.

This is what a rheumatologist will ask for anyway. But whether you have RA or not, if there's any activity in the joints at all, it's a good idea to get a baseline x-ray against which recovering or worsening of the conditon could later be measured.

As for your blood results... It's fairly well known that 20% of RA sufferers are sero-negative=14px. Again, I'm one of those. S=14pxo your GP shouldn't be dismissing your condition as a result of your bloods.

Sero-negative RA is diagnosed clinically and has to be treated in exactly the same way as the regular, 'certifiable' RA.

I've read your post again and my concern would be your losing function in your hand... if there's no pain in the joints or those fingers that won't connect, then this has to be neurological, I would have thought.

So please don't waste time. Get the referral you need.

I wish you all the best.  

11

Hi. Thanks for your response. RA is the only thing I know of that would explain all my symptoms. Plus, there's a family history. I'm just not convinced that's what it is. 

I have been referred to a rheumatologist now, so I'm just trying to prepare while I wait for the appointment. And writing it down helps me keep track.

There is definitely symmetry with my pains. Not necessarily at the same time but each time a new joint has got involved, its sister has joined in shortly after.

I get a lot of pain in my wrists and I think the loss of hand function may be related to this. I think my other hand is now developing the same problem, getting weaker. 

The 'bunion' is potentially my key to diagnosis. Last autumn I started to get pain in the base of the big toe on my left foot. One day in October it swelled up while I was walking and became excruciatingly painful.

A locum GP observed the swelling and warmth in the joint and told me it was gout. She sent me for a blood test. I am not exactly a prime candidate for gout (female, 36, ideal weight, not a beer drinker).

The swelling went away but I continued to get pain in the big toe joint. Then I started to get the same pain in the base of the big toe on the other foot. That's the one that has now developed this 'bunion'. 

When I went back to the GP (a different one) a few months ago with these new joint pains and hand numbness, I mentioned the 'gout'. The GP checked my blood test result from October and told me it wasn't gout after all.

I know everyone's experience is different. I'm just waiting for someone to say "That's exactly what happened to me and it turned out to be x, y or z". I know that's probably not going to happen. I'm just a bit fed up with not knowing what I'm dealing with.

Thanks for listening!

12

Hi to Light and Elbmow;  just a tiny input re the "bi-lateral"  comment....I don not suffer from Wide-spread RA (just in One knuckle on my R) hand...starte back in early 2012, and has Not progressed to any other joints....been seen and confirmed by Rhuemy, and bloods done, etc...but No other joints affected..thank goodness...have OA in All other joints, plus other conditions)....just wanted to let you know, that it can just affect one joint (from my own experience....but is not the norm).......good luck elbmow...for as you say "all you want is a diagnosis, and have IT  treated".....................Bron

13

Yes, it does sound like RA.

You didn't say anything about the burning on the soles of your feet. That's most likely peripheral neuropathy. It's auto-immune too, but not the same as RA.

I also have both.

By the way, I think the "prime candidate for gout" idea is something of a myth. We used to think it was the result of eating too much fatty meats, creams and beer. That has been debunked I believe. Anyone can get it, just like RA. My vegetarian active non-alcohol-drinking friend got it about 10 years ago.

It went away, and that's the good part. Unlike RA, which is with you for life.

Good luck with your results!

14

Hi Light and others; Peripheral Neuropathy can be a result of a few conditions; however, if taking Prednisone, which can result with Type 11 diabetes, which can then cause Hardening of Arteries/Veins , and this causes the Neuropathy. PN often occurs in Diabetic Type 1, too: another being Cardio-vascular Disease....all related to the condition of the arteries/veins. meaning less Blood flow to extremities (arms/legs/fingers/toes)...this is where you will feel the Numb sensation, and needs continual observation, as if when decreased circulation, reaulting in Less oxygen supply, and then any damage/trauma/sores/ulcers etc, will take longer to heal.....Also agree with the piece re Gout...this too is usually an inherited auto-immune disorder, similar to OA  and RA....all in the same family of conditions...but much easier to treat...............Bron

15

Hi Bronwyn,

Thanks for that re PN.

Actually I've had it for far longer than RA – so before preds – and if anything it improved rather than got worse.

I suspect the sort that's a result of diabetes is quite different, though some of the symptoms may be similar.

You've just reminded me that, strange as it may sound, many of my earlier PN symptoms (burning all over shoulders and tight-band feeling on legs) quickly improved after I had all the amalgams removed from my teeth and replaced with procelain (or whatever white stuff it is they put there).

This was quite unexpected but quite miraculous.

To this day my dentist is convinced there was no relationship between the two things, but the timing was extraordinary. My dentist was against my having the amalgams removed in the first place, so there may have been some ego-action involved in her denial too. 

16

No Light, I think you are Right....that is the reason they Stopped putting in Amalgams,,as it was a health risk........xx  Bron