After yet another visit to my Rheumy, he says the pain and disfigurement in my thumbs and feet are because of Osteoarthritis.The pain is severe at times. He says to see a foot Dr. about surgery.I don't understand why he seems to dismiss the pain and snarling joints like it is not RA so it is not associated with him. He doesn't ignore me, but he says "that is the OA not RA" This time I said "and what do I do about it?" He said to see a foot Dr. about feet (and I would imagine an Orthopedic about my hands). Could someone please explain this to me? I always thought the "snarling and disfigurement" would be associated with RA. Has anyone had similar problems. Thanks.
Q: Pain inthumb and wrist joints snarling and disfigurement of the feet? My RA says it is OA?
Answers (1)
9/15/09 3:49pm
There's no sugar-coating this: your rheumatologist sounds like a terrible doctor. This doctor cannot even consider that your very classic RA symptoms are just that? You might think about going to somebody else. My guess is that your rheumatologist is an older person. Many older doctors typically don't know cutting edge medicines or treatments and tend to have terrible listening skills.
Disfigurement of your thumbs (when the thumb joints look sharp and angular) is pretty common with RA. If your RA medications are correct, you should not continue to have disfigurement or severe pain. Feet pain and swollen tender fingers are absolute torture; however, wrist pain falls into its own terrible category. An orthopedic doctor or your rheumatologist can inject cortisone directly into your wrist joints. The cortisone shots can help a great deal if your RA meds are correct.
9/16/09 12:40pm
My doctor is also a young guy in his 30's and he's fabulous. I absolutely trust him and he never pooh-poohs anything I'm saying.
It might be worth it to go ahead and pay for the cortisone shots. I got to a point where my wrists were so deformed and painful that I couldn't think straight. (I was working in a law firm as a legal assistant with a lot of typing.) One shot per wrist has lasted more than 5 years for me. The nodules disappeared and my wrists look fairly normal. Another med that seemed to help me with wrist pain is Azathioprine (name brand Imuran). Have you tried that one?
9/17/09 12:43am
WOW...5 years from one shot of cortisone? I have had many cortisone shots, but I am sorry to say I have only gotten relief for less than a year. I have had each finger, knees, shoulders, hips, nearly each toe joint injected....and have had great relief at the moment. It just never lasts long enough. EACH injection is around $400.00 , too much to have to pay yearly. Each...times the various locations. I bearly get done paying for one year and I need another. I recall hearing of Imuran, however I don't remember whether I took it or not.(more than likely not). I don't remember if I included all of my meds in a previous email...but I take a lot of them. I always say "I want to wipe my own behind for as long as I can"...LOL
I really appreciate your thoughts and ideas Allison. It is very nice to hear from a person with similar experiences . I value your opinion. Thanks!
9/17/09 2:49pm
You made me laugh. I can remember thinking something along those same lines.
One shot of cortisone per wrist PLUS $30,000 worth of medicine each year. It's a miracle how that all works together.
Take care!
10/ 2/09 4:23pm
I'm really surprised at the cost of the shots you mention. I have not been charged that. But maybe it depends on the joint, and who does it. I've had a shot in the hand for deQuervain's (actually that was the beginning of my RA, but NOBODY GOT IT!)
My rheumy has said something similar about OA in my wrist, but guess what. The OA FOLLOWED the RA. RA usually affects the "proximal" joints (closer to the body) and OA the "distal" (more distant from the body) joints, BUT it can affect the distal ones after or while it is affecting. HOWEVER, what ever it is, see an orthopedist or orthopedic surgeon that SPECIALIZES in either hand surgery or foot surgery (or "upper limb) and "lower limb". I've been to both and gotten good evaluation and treatment. I've had ankle/foot surgery and am scheduled for THUMB SURGERY in January. The DeQuervain's shot loosened up the 'proximal' joint of the thumb but led to the swelleing that wrecked my wrist (you can't win sometimes!). But i have had swelling in the distal joints from before RA. However the two are mixed, OA can follow because RA has already done damage, and OA (wear and tear) proceeds from that damage. So it's really a moot question.
I have to agree that if the rheumatologist isn't concerned about your hands, you should maybe bop him one on the head! Stand up for yourself and say, "If this isn't your specialty, please refer me to someone. It is STILL ARTHRITIS, and I am your patient, therefore you should be concerned because it's affecting my function and quality of life." (So there - I need to do the same!)
10/ 2/09 4:31pm
I agree with Ellen. If he still is not listening to you, definitely bop him on the head! If your hands are hurting too badly, bring your best friend along to do that for you! 
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Thank You Allison, but my rheumatologist is a young guy in his early 30's. I know cortisone shots help a great deal, however my insurance does not pay and they can get very costly. But I am so glad to hear that you think it is the RA as well. I am taking quite an agressive number of drugs to try to combat the disfigurement so I am rather perplexed as to this latest comment. Might I add that I am a single person and I am a hairdresser. Unfortunately we have no benefits, but I NEED my hands. I had thought up until recently my RA meds were working for me just wonderfully. Thanks again for your imput I really appreciate it! Oh yes, my RA Dr. says that the angularness of my wrist and base of my thumb is from bone spurs......? Has anyone else ever heard of this?