DEAR DR. GOTT: My friend who is 53 has swelling and pain in both of her hands – especially the first two fingers. One of the fingers swelled so bad her doctor referred to it as “sausage finger”. The skin actually split. She can hardly bend her fingers, she can’t hold any utensils. She has had blood tests for gout and Lyme disease which came back negative. One doctor gave her prednisone for 7 days which helped the swelling some but not the pain. This has been going on for about two months.
Do you have any ideas as to what this might be? No one here seems to be able to figure it out! Thank you for any information you can give us.
DEAR READER: There are several conditions that can cause severe swelling of the fingers such as tophaceous gout and the diseases associated with spondyloarthritis. The most common is psoriatic arthritis, an inflammatory condition that causes pain and swelling of the joints, particularly involving the fingers and toes. It most commonly appears in people with known psoriasis. Fingernails or toenails may become pitted with small holes through them and they may lift from their normal positions and require removal. The location of pain and swelling may be over your friend’s tendons and ligaments. She may have heel spurs or tendonitis of the cord at the back of the heel. Psoriatic arthritis presents in one of two ways. The localized type carries mild symptoms and develops gradually, whereas the generalized form is more serious, affects five or more joints and can ultimately lead to disability and joint damage.
Unfortunately, there is no single test for diagnosing psoriatic arthritis but a physician may order blood tests and X-rays since there are numerous treatment options available for the control of symptoms. Genetics play a big role so if someone in her family suffers from arthritis, that might help her physician zero in on the correct diagnosis.
Non-steroidal anti-inflammatory drugs (NSAIDs) available over the counter should help the condition by reducing the pain, swelling and stiffness experienced. If these fail to help, prescription drugs might be the next step. Keep in mind that there could be unwanted side effects to include kidney damage, abdominal pain, diarrhea and more. Even with split fingers, however, there is no point in trading one problem and taking on another so she should definitely speak with her physician for direction in this regard. Severe cases of the condition can be treated with disease modifying anti-rheumatic drugs such as methotrexate, hydroxychloroquinine, gold salts, and others. On the downside, it may take up to three months before any appreciable difference is realized. Then there’s biologic response modifiers (such as Humira, Enbrel and Remicade) that are comprised of genetically changed proteins that block specific areas of the immune system; however, they must be taken with extreme care because her immune system runs the risk of being compromised. Lastly, there are corticosteroids such as prednisone that act as anti-inflammatories. Some are taken orally while others can be injected directly into the affected joint(s). There are numerous side effects and risks for the individual taking steroids. Again, this is another area that must be discussed at great length with a primary care physician, dermatologist, or rheumatologist.
Your friend should see a specialist if she hasn’t already done so. Light therapy might be of benefit for the psoriasis. Ice or heat applied (the response varies) to her hands should relax her muscles and help reduce the pain and soreness. Exercise, under the direction of her physician, should also help control the pain and stiffness. This can range from stretching to water aerobics.
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