A common question I get from patients as well as from referring physicians and colleagues is when should you consider that somebody’s hand pains may be the sign of rheumatoid arthritis. I discuss my approach in this video.
If your hands hurt, when should you suspect that you may have rheumatoid arthritis?
A common question I get from patients as well as from referring physicians and colleagues is when should you consider that somebody’s hand pains may be the sign of rheumatoid arthritis. To start with, what is rheumatoid arthritis? Rheumatoid arthritis is an autoimmune condition which means that your immune system, which is made to protect you from viruses and bacteria, unfortunately recognizes your own body. In this case, your joints as being foreign and then causes a reaction where the immune system is attacking the joints and tendons that it recognizes as problematic. This leads to inflammation, swelling, pain eventually damage and dysfunction in the joints. Classic symptoms of rheumatoid arthritis include pain and swelling in the small joints, meaning the hands and the feet. Typically pains are worse with rest and better with activity.
Diagnosis is generally made by a combination of classic history, examination findings, imaging findings, and labs as confirmation. So when should you consider that you may have rheumatoid arthritis. First and foremost, do you have the classic symptoms of this condition. Namely, pain and swelling in the hands and the feet. Symptoms that are classically worse first thing in the morning and better with activity. Pains that are generally worse with activity and better with rest, are generally caused by wear and tear arthritis or tendonitis rather than your immune system such as rheumatoid arthritis. In addition, these symptoms tend to be chronic, meaning symptoms that have been ongoing for more than six weeks. They don’t spontaneously resolve on their own.
So if you have these classic symptoms in your hands what are the next steps that you should take? I would strongly recommend seeing a board-certified clinical Rheumatologist. Most physicians, whether that’s your primary doctor, orthopedic surgeon, or other types of doctors who are used to seeing pain, they’re not used to seeing these kind of autoimmune conditions. A Rheumatologist at that point then should be able to take a look at your history of how you’re describing your symptoms. Then doing a thorough examination to look for inflammation in the joints. And then utilizing imaging as well.
The imaging study that I strongly recommend is diagnostic musculoskeletal ultrasound. Unfortunately, most rheumatologists are not using this at the bedside in a routine manner. If they do however, they can very quickly and efficiently see whether or not you have inflammation in the joints rather than having to wait for an MRI. X-rays on the other hand are not very helpful for looking for inflammation. They are helpful if you’re looking for wear and tear arthritis. And MRI can be very detailed and helpful for looking for inflammation. But again, ultrasound can be done at the bedside and is a lot cheaper and a lot faster to help make your diagnosis.
Lastly, the kind of labs that they should be looking for include; do you have the classic antibodies such as the rheumatoid factor and CCP antibody, as well as if you have inflammation on the labs including labs such as your SED rate and CRP test. The last thing is, they should be trying to rule out other conditions such as wear and tear arthritis, if your thyroid number is off, if you have other types of endocrine or hormone-related etiology for pain. If you have nerve-related pain or anything else that could be causing your symptoms at that time.
Based on all of that, they should be able to make a diagnosis or rule out rheumatoid arthritis in a relatively efficient and reliable manner. And then, based on making your diagnosis, they then should be able to put you on the right track for treatment for the cause of your pain and swelling.
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