What causes swelling and pain in DIP joints?

Question

Hello doctor,

I have had pain and a tiny bump on right pinky (DIP) for over six months, only when I touch it. Now I have slight stiffness in two other DIP joints and one PIP joint (same R hand which I use a lot on the computer, maybe two hours a day). Also one DIP joint other hand. It got much worse with my allergies this month, and I have had a lot of stress in the past few months.

I also have pain in my left toe and possibly have Morton's neuroma between toes 3/4. But I have terrible flat feet and was walking a lot for three weeks with sandals. I have been home for three weeks and it is not better. So, I went to my doctor and he thinks I have rheumatoid arthritis. He says it starts in the feet and hands. Blood workup is totally normal for RA factor and inflammatory markers. This is causing me severe anxiety. He did not take X-rays but says he can see changes in my hands. They look the same to be as I am petite and have always had bony hands. He is a rheumatologist but did not even touch my hands to examine them. I have had no fevers, tiredness, anemia, etc. Just now a lot of anxiety over this.

Can this be allergies with some slight osteoarthritis? Stress inflammation? Also, I am starting menopause as I am 48 years old, no period since last month. Hormones? I do have a slightly swollen gland under right ear and right side of throat is sore from postnasal drip, also had cold sores in the mouth. I do not know if a virus can affect this also. I will upload the blood report.

Answer 1

Hi,

Welcome to icliniq.com.

Well, as per your clinical history, symptoms, and reports (the attachments removed to protect the patient's identity), it does look like nodal osteoarthritis of the hands. My point in favor:

DIP joints are never involved in rheumatoid arthritis. If they are inflamed, we have to think of alternative diagnoses. Either OA or psoriatic arthritis. But from your history, it seems more like nodal osteoarthritis with Heberden's nodes and Bouchard's nodes.
If it were rheumatoid, even if seronegative, ESR and CRP should have risen, but they have not. So, it is unlikely there is any inflammation going on.
As for your feet, it looks like you developed plantar fasciitis. Would recommend you start wearing sports shoes and do some compressions in a hot water tub. That should help.

Apart from it, the swollen gland may be due to a viral infection only, which I am hoping should settle in due course. But yes, if you need a final confirmation, the best thing to do is to ask for an ultrasound of the hands and feet, which would tell us if there is inflammation or not, because you do not have a history of fever, anemia, or fatigue, and X-rays may not pick up early changes.

You can always come back and reach me at icliniq.com.

Thank you for consulting me.

Answer 2

Hi,

Welcome back to icliniq.com.

Well, yes, that is a possibility. Therefore, we rely on our clinical findings. If there is swelling, tenderness, and redness in the joints, we identify it as inflammation, paying particular attention to the pattern of involvement. Based on your history, the involvement of DIP joints suggests against RA. Often, osteoarthritis is mistaken for rheumatoid arthritis, which appears to be the case here.

However, for your and your rheumatologist's satisfaction, you can request an ultrasound or MRI of your hands. If inflammation is detected, it would justify starting treatment. Despite normal inflammation markers, negative arthritis tests, and clinically insignificant inflammation, we should have some evidence to initiate long-term DMARDs (disease-modifying antirheumatic drugs) for you.

You can always come back and reach me at icliniq.com.

Thank you for consulting me.