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Living with Psoriatic Arthritis (PsA)

Finger joint pain


#1

I have had a lot of pain in my ring finger PIP joint and the middle finger also, some in the DIP’s but not as pronounced, also inflammational swelling. US imaging dx said that there was erosion, synovitis, inflammation, and also OA. Recently I have seen that OA has been identified as having synovitis, entheistis and inflammation, how can the Dx be narrowed down to PsA? Erosion? I guess duration it has pain, onset and the action that brought it on can also be indicators. Also I heard that PsA can cause secondary OA at the enthesis points, and OA can have a sudden onset, along with PsA. The joint is getting moderatly damaged, so at some point both conditions would cause continous pain. Any other factors I am missing?
The reason I am asking, I am concerned that my Remicade infusions may not be effective anymore, if thisis causingthe pain, or is it OA, that will not be affected by biologics…


#2

I guess that I wouldn’t consider one joint to be particularly indicative of a biologic failing. Look at more of an overall pattern. Are there multiple joints with significant swelling? What’s your overall wellness level looking like?

My mom’s hands were destroyed before diagnosis. She actually had surgery on both hands with joint replacements and fusions. It’s amazing how much function she gained, and how much better her pain is.


#3

I get swelling in my other fingers and toes. I usually see most improvement with neck, shoulders and legs. Also a lot of fatigue that goes away after the infusion, doing pretty well today, butthat last week has been pretty bad with stiffness in the morning, making it hard to walk.
I think it is primarily enthesitis and fatigue, with systemic inflammation. When I had a nuclear bone scan before starting biologics, I had hot spots all over.


#4

Here is how the toes look…


#5

I have found that PsA causes intense pain in joints whereas OA causes ongoing nagging pain. The word ‘erosion’ is usually indicative of damage caused directly by PsA, isn’t it? I guess sometimes it may be used inaccurately & confuse matters. Joints that are affected by PsA can get OA as well as erosions, absolutely anything that compromises / stresses joints can cause OA.

Your toes look okay to me, but everything’s relative. Mine are basically stuffed and have a load of OA damage, I reckon PsA has played its part. My theory is that PsA rumbles on in my feet, wrecking them slowly despite overall success treatment-wise. Some docs have agreed with me on this, others not so much. The main thing is I can still walk on the things, they are troopers. I don’t think I’d ask for a change of biologic unless there was more flamboyant or extensive joint pain & swelling.


#6

I guess so, the toes are inflammed in the photo, they get puffy and stiff. But like you said, My feet can still get me around… I think the pain is more pronounced when the finger joint is damaged.


#7

I was beginning to think the pain in my finger joints were OA, but aftermy Remicade infusion, all the pain and swelling has gone away!
My Rheumy agreed to do ultrasound imaging on my two fingers next infusion.

BTW It was the infusion from hell! Got stuck about 10 times, she was running out of needles. The first one was flowing great for about 30 minutrs, then colapsed and infiltrated my arm, so she switched to the other arm, same thing, but sooner, then the left wrist, which was several attempts, then my wrist blew up like a balloon, so the other wrist and top of hand, nothing, still had about 3/8’s of the bag to go, she then went back to the first site, but on the top of my arm, it started flowing so she cranked it up! Got it all infused, but felt a little weird, because it was going in so fast… This is the 7 vial dose!
Next time I am going to load up on electrolights, even though I drank a lot of water, maybe this will help?


#8

Ouch, doesn’t sound like a lot of fun! Actually the electrolytes sound like a sensible thing to try. Out of curiosity, what is the volume of the infusion?


#9

It is a large bag, Liter?
Bought some electrolites they are called “Liquid IV”, thought that was a appropriate name…


#10

Yeah, to a layperson like me, that sounds like it could cause quite a lot of dilution of your electrolytes, enough to feel weird and lousy, anyway. I gather it has a fair bit to do with how efficient your osmosis is, but it can’t hurt to make sure you have the electrolytes immediately available to help it out. Love the name!! :joy:


#11

I was diagnosed with PsA a few years ago. My right hand has always been swollen and painful. The ring finger and thumb started to lock and then the thumb started to get very painful at the joint base whenever it was touched.

My RA doc advised it was actually not related to the PsA but called trigger finger, which is like carpel tunnel. The thumb is now healed after I had an ortho doc perform outpatient surgery.


#12

I wonder if they have that figured out yet, seems the scienceis not settled with PsA and enthesis… I had two surgeies on my pinky trigger finger, still have not resolved.
The tendon catching on the pully… http://www.enthesis.info/anatomy/bony_pulleys.html


#13

I would thoroughly disagree that trigger thumb and carpel tunnel syndrome aren’t anything to do with PsA. Both involve inflammation issues, serious inflammation issues. I worked as a lawyer in litigating upper limb work related disorders involving such issues as trigger thumb and carpal tunnel syndrome, so got to know all about both and some more. Think your RA doc needs some education. But both can be eased by the operations the orthopaedics do.


#14

Not to mention synovitis inflammation that can also make trigger finger worse.


#15

And of course that it’s synovitis inflammation that causes carpal tunnel syndrome in the first place.