Got a Medical Question? Ask a Doctor Online!
Since June I have developed pain and stiffness in all the joints of all my fingers. At first, it is most noticeable when I first wake up, then shortly subsided. Now the stiffness is present sometimes throughout the day. Further, now when I make a fist my middle finger joints crack. I don't have any visible swelling except for the top joint in my right small finger. That finger hurts when I apply pressure on it and the joint is raised and the end of the finger is pointed down at about a 45 degree angle at the distal phalanx joint. I have seen two rheumatologists. One said I had inflammatory arthritis (erosive arthritis) while the other disagreed, stating she believe it was "just" osteoarthritis. The first rheumatologist ordered the following tests:erythrocyte sedimentation rate, C-reactive protein level, rheumatoid factorWhen I asked for the results, I received the following response from the first rheumatologist:Your CRP was mildly elevated but that is not specific for anythingYour other tests were all normalQuestions: How do I determine which diagnosis is correct?Can I be confident I don't have RA? Should I request an Anti-CCP tests to rule out RA or is that not necessary? I have read where the RA factor test is not very reliable for diagnosing RA early in the disease.The first doctor recommended exercising my hands; e.g., squeeze ball; doing dishes; the second doctor actually recommend against that except for just very brief exercise of the hands.P.S. Here is radiologist's impression from 9/28/12 X-Ray of right hand:Bones: There is no apparent fracture. No osseous lesions are identified. Joints: Osseous alignment is maintained. There is mild narrowing of the interphalangeal joints most severely affecting the DIP of the fifth digit with mild osseous spurring. An inflammatory arthritis is suspected. Soft tissues: The soft tissues are grossly unremarkable. No radiopaque foreign bodies are seen. IMPRESSION: Interphalangeal joint space narrowing most severely affecting the DIP of the fifth digit with secondary osseous spurring; an early inflammatory arthritis is suspected.
Male: Age 56
Let me know if you have further questions. If you have any concerns just use reply to expert until you are ready to rate a positive for your satisfaction..
Please click on one of the positive ratings [smiley faces]: the only way we are compensated for time and expertise. If you are not done or satisfied, use reply to expert [not poor/negative]. Come back anytime. Bonuses are great…but your satisfaction is my goal.
Future questions? Ask for DrThomas in the question title or see my profile to request me. Save my profile to your browser favorites http://www.justanswer.com/medical/expert-dr-thomas
Ok, thanks. But why didn't either doctor recommend an MRI?
Should I request an Anti-CCP tests to rule out RA or is that not necessary?
And if not RA, how do I determine whether my condition is inflammatory arthritis (erosive arthritis) or "just" osteoarthritis.
Please opt out. Thank you.
I would appreciate if you read my original question and provide a reply if you have experience in this area. Thank you.
My first rheumatologist was Dr. Nancy Lane from a highly rated teaching hospital, UC Davis. The second rheumatologist was a long time rheumatologist from the Sutter Medical Group in Sacramento, JaNahn C. Scalapino, M.D. Both are board certified.
I was hoping that you could respond with recommendations on what to ask for to be able to differentiate between the two diagnosis, or to rule out rheumatoid arthritis. Are you an orthopedist? Thank you.
Ok, but can I be assured that I don't have RA after these two visits? Right now I am told there is nothing I can do about my condition; it will progress or not progress regardless of my actions. Do you agree with this?
Would you recommend either an anti-CCP antibody test to rule out RA
and/or seek to obtain an MRI, or should I be extremely confident that I don't have RA based on my visits to these two board certified rheumatologist?
But I am not second guessing them because they have come up with two different diagnoses. And some information on the net indicates that for OER that Remecade cause deformities to subside.
Further, OER is generally more aggressive and debilitating, and the doctor that diagnosed OER recommended hand exercises while the other that diagnosed OA expressed caution with regard to this activity.
Have you heard of an MRI being valuable to distinguish either from RA or to distinguish OER from OA? Thank you.
That is what I am looking for you to assist me with. Are you an orthopedist?
I am looking for what criteria I should look for to distinguish which condition I have so when I meet with another rheumatologist I will be an educated patient. I was somewhat taken aback when neither rheumatologist placed my x-ray against a lighted back screen to examine. They just looked at the film by holding it up to the ceiling light and never did respond to my query regarding the degree of erosion or cartilage loss they saw. I don't think the first doctor would have even ordered the blood tests if I wasn't insistent.
And the internet has knowledge that many doctors are not aware of so don't dismiss it so fast. For example, my primary care doctor had no knowledge of a free PSA test, although that severed as a main criteria for the urologist ordering a biopsy, and I have had urologists make diagnosis that were not reliable based not only on information on the internet but in medical textbooks. If a web site is reliable such as Medline, the information should not be just discarded because it came from the "internet".