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I am enquiring about a very painful, swollen hot knuckle

Hi...I am enquiring about a...
Hi...I am enquiring about a very painful, swollen hot knuckle joint of thumb, right hand. This has happened previously, at which time my rheumatologist injected the joint using ultrasound. This provided relief. At that time, he had been somewhat concerned about possibility of infection, but eventually discounted that and proceeded with injection. The possibility of MRI was discussed, but we did not proceed with that option. Now, about 6 months later, the condition has returned seemingly overnight. Thumb is so painful and swollen that the pressure makes even the fingernail hurt. I have RA that has been pretty well controlled with moderate dose of MTX; no biologic (my choice). Any thoughts would be appreciated. Sharon
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Answered in 5 minutes by:
7/31/2013
911DOC
911DOC, Board Certified Dr.
Category: Medical
Satisfied Customers: 5,094
Experience: Emergency Medicine Physician
Verified
911DOC :

Dear *****,

911DOC :

are you able to speak with your doctor today?

911DOC :

Did he mention gout as a possibility?

911DOC :

I'm glad they ruled out infection as a joint infection can be very dangerous indeed.

911DOC :

standing by

911DOC :

place your cursor in the box below, type, and click 'reply' and i will see your response.

Customer:

No, my Dr. is not available today. I inquired about gout previously, but Dr. said my regular bloodwork (every 3 months, comprehensive blood panel) would have indicated that. Not sure that uric acid level would be a part of that panel?

911DOC :

probably would be, but to definitively diagnose gout fluid from the joint needs to be studied.

911DOC :

let's assume this is either a flare of RA or even that it is gout.

911DOC :

in either case Tylenol (vicodin has Tylenol in it)

911DOC :

is not the best choice

911DOC :

something like motrin or even aspirin would be better

911DOC :

can you get in to see someone today to make sure this is not an infected joint?

911DOC :

your primary care or even an urgent care?

911DOC :

standing by

911DOC :

as you can see from THIS REFERENCE this could easily be a flare of your RA

911DOC :

standing by

Customer:

How about celebrex for the inflammation? It is my last ditch standby. If I take the celebrex, will it mask infection or not? So perhaps I should take the celebrex, and if no improvement, then seek an appt. to have the thumb evaluated? Yes, I checked the link...thanks.

911DOC :

That would be a fine choice as it is also an NSAID, anti-inflammatory medicine.

911DOC :

You could also take the vicodin as prescribed as the two do not interact

911DOC :

if you need to for pain

911DOC :

and yes

911DOC :

i think your plan is very reasonable

911DOC :

if the redness starts spreading to the hand or wrist or arm it's time to be seen right away

911DOC :

does this make sense?

911DOC :

standing by

Customer:

Yes, thank you. So you do not think that the celebrex would mask an infection if one were actually present?

911DOC :

no, it will not mask it.

911DOC :

do you have any final questions about this for me?

Customer:

No, thank you for your input!

911DOC :

you are most welcome

911DOC :

Thank you so much for your question. It was a pleasure talking with you. Should you need my assistance in the future simply start your question with ‘for 911doc only’.

Positive feedback is always appreciated.

Be Well

911Doc

911DOC
911DOC, Board Certified Dr.
Category: Medical
Satisfied Customers: 5,094
Experience: Emergency Medicine Physician
Verified
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911DOC
911DOC, Board Certified Dr.
Category: Medical
Satisfied Customers: 5,094
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