DEAR DR. GOTT: I was wondering if you could help answer a problem I have been having. For about the past year, at least four times a week I will wake during the middle of the night with my fingers feeling very swollen and stiff. I don’t believe they are actually swollen but they are so stiff I can hardly close a fist.
When I get up in the morning they are not abnormally stiff any more. I do have a slight case of psoriatic arthritis but I always believed that when we slept our bodies healed themselves. Is there anything I can do to prevent this and is it something I should see my doctor about?
DEAR READER: As a general rule, I feel strongly that each person knows his or her body, its limitations and its strong points. If something is out of the ordinary and there could be an underlying cause, a trip to the doctor is appropriate. The visit may be for nothing and I am not attempting to turn every reader into a hypochondriac; however, there are instances when the act will pay off. Let me give you a for instance:
A middle-aged man I know presented in his doctor’s office because of a cold he couldn’t seem to shake. The doctor listened to his lungs, drew some blood and then asked if anything else was going on. The patient replied he had a nagging headache he believed to be part of the “cold”. Further inquiry from his doctor found the man never suffered from headaches in the past but did fall on the ice, hitting his head a couple of weeks prior. Bells rang, whistles blew, a red flag went up and an immediate CT scan was ordered at our local hospital. The result – a subdural hematoma that may never have been discovered if the doctor hadn’t taken the time to get to the bottom of the cold issue! What appears so simple may not be! Enough said.
Swelling occurs when excess fluids become trapped in tissue and swollen hands or feet can occur because of variety of reasons – from idiopathic edema to kidney disorders. Some women suffer from idiopathic edema during a portion of their menstrual cycle. This condition’s cause remains unknown but it occurs primarily in premenopausal women who do not have any evidence of liver, kidney or heart disease.
You admit to psoriatic arthritis, a form of chronic inflammatory arthritis. Psoriasis can occur at any age but is typically diagnosed in individuals between the ages of 15 and 35. In a portion of these individuals, psoriatic arthritis may appear about 10 years later, causing joint pain, swelling, limited range of motion, morning stiffness, and more. It affects the hands, feet and spine. Are you on any medication that could cause the swelling? Speak with your prescribing physician and if so, ask for another drug in the same class without the unwanted side effect. Do you have fibromyalgia that presents with joint stiffness, tingling, numbness, and pain? Do you have carpal tunnel syndrome or use your hands extensively during the day, such as doing typing? Could you be hyperflexing your wrists during sleep?
Do you add salt to your food while cooking or sprinkle some on your prepared food once it is on your plate? Do you regularly eat salty foods or snacks? If so, you might want to discontinue the habit to determine if any change is noted. On the flip side of this, swollen fingers and hands could be a sign of hyponatremia, too low a level of sodium in the body that could be the result of drinking too much water during extreme exercise or too little salt in the diet (although you would also experience other signs and symptoms on top of the stiff, swollen-feeling fingers. We abuse our bodies every day yet for the most part, they are delicately balanced and perform well for the long haul.
I recommend you keep a journal. Make a list of the foods you eat and what you drink. Review it at the end of the week. Compare what you have consumed with your middle of the night awakenings. Then make an appointment with your doctor. Advise him or her of any supplements or herbs you are taking. You owe it to yourself to get to the bottom of the issue. With your physician’s guidance, it will happen.
Readers who would like related information can order my Health Report “Fibromyalgia” by sending a self-addressed, stamped number 10 envelope and a $2 US check or money order to my attention at PO Box 433, Lakeville, CT 06039. Be sure to mention the title when writing or print out an order form from my website www.AskDrGottMD.com.