As the story was unfolding in Part One, I shared that my neurologist had referred me to a hand surgeon to be evaluated for treatment of Carpal Tunnel Syndrome.  The hand surgeon injected steroids into each wrist which relieved the swelling, pain, and dysfunction.  He stated that when/if the pain returned that my next step would be Carpal Tunnel Release surgery, a procedure I was greatly fearful of and didn’t want to undergo.  However, he also referred me to a rheumatologist to be evaluated.

My first appointment with the rheumatologist was exactly two years ago.  I brought to the appointment: x-rays of the swollen (and immobile) finger, a note detailing my symptoms and attempted treatments, and a history of blood work.  The rheumatologist used a nifty ultrasound machine to detect inflammation around the joints and possible erosion of the bones in the joints due to arthritis.  The evidence seen on ultrasound combined with the examination, my history of symptoms and treatments, and the current complaints earned me a diagnosis of Rheumatoid Arthritis.

I was thankful to finally get an accurate diagnosis and one for which treatments are available.  “Let’s kick this thing in the butt,” I said.  First decision to be made: which drug therapy(s) to use.  The anti-tumor necrosis factor (anti-TNF) biologics are powerful drugs (Enbrel, Humira, Remicade) but cannot be used by persons who have multiple sclerosis or other demyelinating disease as I do. 

So the recommendation was to utilize a Triple Therapy approach which combines Methotrexate, Sulfasalazine, and Hydroxychloroquine (Plaquenil).   The concept of Triple Therapy is not new, but one which has been popular for over a decade.  (See O’Dell JR, Haire C, et al. Treatment of Rheumatoid Arthritis with Methotrexate Alone, Sulfasalazine and Hydroxychloroquine, or a Combination of All Three Medications.  The New England Journal of Medicine.  1996(20);334:1287-1291.)

I started with Methotrexate, added Sulfasalazine, and finally Plaquenil.  However, plaquenil caused an odd side-effect in me: overwhelming fatigue and lassitude.  Basically, I couldn’t stay awake during the day, so I quit that drug within the first week, leaving me with a double combination therapy to battle the rheumatoid arthritis.

Thankfully, I responded well to the drugs.  However, when the swelling finally went down, I was left with two crooked fingers which no longer could be pointed directly straight.  I had developed a Boutonniere Finger deformity. 

Next stop on my journey was to the Occupational Therapist at the local hospital outpatient rehabilitation center.  The prescription was for the therapist, who specializeds in hands, to teach me proper joint protection techniques and to be evaluated for intervention and treatment of the mild Boutonniere deformity.