Great - thanks for that info.
As a RN, I'm sure you konw that all small joint arthritis has to be ruled out for auto-immune arthritis. THus, before anything else, you need an ANA/ESR/CRP to rule out this.
Next, there aren't many other causes of small joint arthritis.
1) osteoarthritis --> not likely given the time frame
2) osteomyelitis --> not likely if you have no signs of infxn
3) Gout --> possible. You should get a blood uric acid level and joint tap.
4) Pseudogout --> Very possible given the situation above and a joint tap is the best way to know this.
Treatment of gout is multifold: 1) what a doctor can do for a patient and 2) what a patient can do for themselves.
1) What a doctor can do for a patient
- Acute flare:
- naproxen or indomethacin
- Vitamin C 8grams daily for 3 days
- Chronic preventative management:
- vitamin C 1500mg daily
2) What a patient can do for themselves:
Forbidden Very high purine content. Herring, herring roe, meat extracts, mussels, Sardines, yeast (brewer's and baker's). Alcohol : Alcohol contains no purine but interferes with uric acid excretion.Liver
Avoid High purine content - not more than one item once a week. Anchovies, bacon, chicken soup, Beef, mutton leg, mutton chop, pheasant, salmon, sausage, trout, turkey, veal, venison, lobster, crab.
Moderation Moderate purine content-not more than one item 4 times a week. Asparagus, bass, bouillon, brains, cauliflower, chicken, duck, halibut, ham, kidney beans, lentils, Lima beans, liverwurst, mushrooms, oysters, peas, plaice, pork, rabbit, roe, shad, spinach, tongue, tripe, tuna, wholegrain cereals and bread.
Acceptable Low or no purine content - as often as desired. Beverages -tea, coffee, cocoa, chocolate Carbonated soft drinks Fruit juices Sugar, sweets Vegetables : (except those under BE CAREFUL) Vegetables and cream soups (no meat stock) Butter, fats of all kinds (in moderation) Bread (except wholegrain) Cereals (except wholegrain) Cheese : all kinds (in moderation) Eggs Fruit Milk - buttermilk, condensed, malted Nuts - all kinds, peanut butter
Drink plenty of water (2-3 litres per day) to help flush uric acid through the kidneys. Please note - if you have cardiac or kidney disease, your doctor may actually require fluid restriction - and you should consult him regarding fluid intake allowance. Keep dietary fat to a minimum.
Be careful not to damage the joint.
Take your prescribed medication regularly.
Read here for Gout information:
Hope this helps and good luck to you!
I see - that makes a neruopathy more concerning or a problem with the nail bed.
You will need the nail examined of course but the other thing you may want to consider is a platelet/coags/and workup for vascular disease to make sure this isn't from microvascular disease.
OTherwise, you may want to consider a trial of lyrica or neurontin.
Does this help?