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Hi Otis, My pain started sometime in January with sore fingers/hands/wrists. The pain ebbed and flowed, sometimes just pain, sometimes extreme pain but non-stop since it began. The pain also changed locations often (thumb, wrist, back of one hand, then the back of the other hand).

Sometime in March I started experiencing knife like pains in both big toes and then I noticed a large bunion on top of my right foot (one week there was nothing there, the next week ... BAM! ... where the heck did that come from?!). My primary care physician sent me to a podiatrist who diagnosed it as an "arthritic bunion" (he explained it was "arthritic" because it was on top of my foot as opposed to the side as is often seen). Insurance wouldn't pay for the custom orthotics he recommended so I went to the shoe store and bought shoes with good arch support (Mephisto's) and they've been great! The toe has been relatively quiet for about a month or so other than the permanent damage (the bunion).

From January ‘til April I had believed that the problem with my hands/wrists/fingers was some type of repetitive injury (however I already knew it probably was not carpal tunnel).  I returned to my primary care doc in April when I started getting shooting pains down the back of my right hand anytime I used it and also to check out my right pointer finger (it was swollen at the proximal interphalangeal joint - sorry had to look that one up - the second joint from the tip of the finger - and becoming very painful). He then sent me for blood work, x-rays of my right hand/wrist and to an orthopedic hand specialist. The orthopedic doc also did x-rays, of both hands and found no evidence of "boney arthritis". He "diagnosed" my swollen finger as "mystery finger" - very helpful (LOL)!

Around this time the pain and swelling seemed to be taking on a life of it's own. Next the left middle finger swelled, then the right ring finger, then both pinky's (not nearly as bad though). My primary then referred me to the rheumatologist I’m now seeing. As things sped up I called the rheumatologist hoping there was a cancellation so that I could get in sooner than my scheduled appointment (managed to get in 10 days earlier) because the pain and swelling was starting to get out of control.

Long story short (apologies for the length), my blood work came out normal (negative for RF factor, normal CRP and normal anti-CCP) however my "rheumy" said they don't go by the blood work alone but also by the exam, length of symptoms, morning stiffness (I was experiencing stiff hands/fingers every morning for about 1-2 hours). “It is important to remember that while blood tests are helpful in confirming a diagnosis and assessment of disease activity, it is more important to diagnose and treat based on the patient's clinical presentation.” http://arthritis.about.com/od/diagnostic/f/normalbloodtest.htm He said that he was 90% sure that I had RA. After expressing concern about the other 10% that I may not have it he said that he would still treat me the same way because we needed to get control of the swelling. He ordered more blood work and put me immediately on Methotrexate (MTX)(once a week)(10 mg to start and adding 2.5 mg each week until I get to 25 mg) along with 5 mg folic acid for side effects.

I had a check-up two weeks later with no improvement (but also no side effects from the MTX) so he put be on "a bridge" of 5 mg of prednisone to get the swelling down until the MTX kicks in. He also gave me a corticosteroid shot in the top of both wrists (both had really started to flare and had become quite painful). It's been 1.5 weeks since the prednisone and corticosteroid and I can feel "the train finally slowing down". The pain has lessened and the "new" swellings have "slowed down" - not disappeared but definitely slowed.

The disease is very confusing as well as the info that many people may believe they know about it. I had relatives tell me that it can’t be RA if my tests were normal however here is info I found online: “Of interest is that if your rheumatoid factor is negative, you are less likely to have a positive CCP. On the other hand, occasionally a patient with RA may have active disease and all these tests are normal. In general, those patients without these abnormalities in the blood are less likely to develop joint damage.” http://arthritis.about.com/od/diagnostic/f/normalbloodtest.htm

My symptoms are in both hands, both wrists, both feet however, the fingers affected are not completely symmetric.

I’m still a little leery of that 10% - what if I don’t have RA but yet I’m taking all of this serious medicine? I going on the believe that for the time being it is my job to educate myself and ask lots of questions. My husband has been completely supportive (he works in research and has had some experience with RA) and he reminds me to take an active part in my treatment and the importance of trusting the experience of my doctor. He also cautions that if I don’t feel right with something question it and remember that I always have the option of getting another opinion. My “rheumy” has been very open, informative, patient, etc. and right now I’m choosing to trust him as well as educate myself.

Otis, I hope I haven’t bored you to tears with my “story” but I thought it may be helpful to you. Also, I don’t know what part of the country you are in but I live in the San Francisco Bay area and my “rheumy” also spent some time at UCSF which has a large RA program there.

Hope this helps! 

A reply to myself (LOL!) - I'm only on 1 mg folic acid, I think I incorrectly said 5 mg.