Hands Hurt

Pauciarticular arthritis.  That's what it's called.  Maybe migratory arthritis.  While the last recommendation I wrote for a resident's fellowship resulted in a Rheumatology match, my own knowledge of arthritic syndromes has taken a major dip over my professional career.

I can describe history.  There is chronic recurrent low back symptoms, classically transient lumbago that is self-limited and responsive to naproxen.  Occasionally my ankles will hurt transiently and I have had an arthroscopy of my right knee about 15 years ago.  All large joints, mostly axial.  No effusions and really no objective exam features of rubor, tumor, calor, just dolor.

This is different.  When I retired I committed myself to a treadmill session, two days on, one day off.  I did a good job until the next back layoff.  Like most things I will make excuses not to do, it gets done most reliably when done first thing in the morning, which I did through my cruise to Europe last fall and into the winter, back permitting.  Then I started noticing some stiffness in the mornings.  Hands were most prominent but axial stiffness as well, pretty much every morning until late morning.  Being retired, I could go on the treadmill any time so I rescheduled this for late morning or early afternoon, with decent compliance if not otherwise occupied at those times.  Other than the morning stiffness, I experienced no constitutional symptoms but had some intermittent carpal tunnel numbness in the expected distributions, always transient.

Earlier this week I awoke with my left ring finger bent.  It looked like a boutonniere deformity and relocated with a snap to its usual position when I gently forced it.  Flexion dislocated this proximal interphalangeal joint again, only to snap back with gentle force.  A few more times back and forth and it stayed in place with mild discomfort.  The following morning it happened again and this time all the proximal interphalangeal joints on my left except the thumb were sore.  Distal joints were fine.  The metacarpophalyngeal joints were stiff and there was slight tenderness over the PIP areas but no swelling or redness.  By opening and closing my fist the stiffness went away.  The right hand seemed only minimally stiff but no pain.  Later in the day I took two naproxen tablets, which would be a full strength prescription dose.  It felt better in the evening.  This morning my left hand is almost back to baseline with slight joint stiffness.  However, my right ring finger became overtly inflamed at the MCP and DIP joints with less involvement of the middle finger DIP.  The MCP and proximal phalanx were far more tender than the left hand ever was and my middle and ring fingers could not make a fist.  Cold water helped, a blue gel cold pack helped less, and two naproxen had less effect on my right hand than yesterdays pills did for the left.  What gives?

The antecedent stiffness suggests rheumatoid physiology but the very transient nature on the left makes me think of other things.  Just have to give the right fingers a few more days, then reassess.