
Have Osteoarthritis, Painful Joints Of Fingers And Thumbs, X-ray Shows Serious Case, Prescribed Naproxen. Does This Serve To Delay Surgery?

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Thanks for posting your wifes report, it was most helpful. She seems to be suffering with some severe form of arthritis which I suspect to be Rheumatoid in nature. The features like radial subluxation, erosion are characteristic of Rheumatoid. Maybe we need to investigate her in that direction as well.
Your orthopaedician is right about the conservative approach. She needs to have prolonged immobilisation with splints. The medications need to be revised though. If she's not responding to naproxen, then an adjuvant should be added. If she tests positive for rheumatoid (even if she doesn't in which she'll be labelled sero negative RA) she'll require Disease Modifying Anti Rheumatoid Drugs or DMARDS along with her NSAIDS. Naproxen is not cumulative, it works for some time after its taken.
There are surgeries to correct the deformity which are reserved as last resort. To remove the bone sounds a little harsh and is not required in this condition.
In my opinion, she still needs to be diagnosed correctly for the type of arthritis, and then treated accordingly. Feel free to ask more, I'm available for follow up.
Regards.


Thanks for replying back.
Almost 70 % rheumatoid patients test negative for serum rheumatoid arthritis factor. Many of them test positive in subsequently repeated tests. So one needs to be more certain of clinical and radiological signs than blood tests. Your doctor might not have suspected this due to a probable less incidence in the region.
Nevertheless, she can be put on DMARD's along with NSAID's empirically (like we do in sero negative arthritis) and observed for improvements. Naproxen afterall is just an NSAID and the response to any drug can be variable. She can be given an even stronger molecule but with added disadvantages.
I hope this answers your query. For any further assistance please write back to us.
Regards.


Another blood test? This
may be useless if 70% are anyway negative. Should she request the DRAM anyway?
Thanks for writing back.
As I mentioned previously, erosions and subluxations are usually not seen early in OA, neither is affinity towards small joints. Besides she is not responding to NSAIDs.
Ask the orthopaedician or rheumatologist to reinvestigate in lines of autoimmune disease till we get the evidence of presence or absence of RA.
As I said, most of the people in those 70 % are later tested positive in subsequent tests. So she has a chance of knowing for sure in later tests. I am not sure what you mean by DRAM, can you please specify.
Thanks once again and shall await your further response.
Regards.


And do you mean she has bee.been developing both rheumatoid and osteo arthritis simultaneously in her fingers? What could be other symptoms of rheumatoid? I thought the two forms had different symptoms. She doesn't have swollen nuckles.


Thanks for writing back.
Rheumatoid arthritis is a type of autoimmune disease, that can be proved to be present in a person by certain tests. Whereas osteoarthritis is an age related wear and tear disease. She cannot have two types of arthritis active in same joint.
The main symptoms of RA are multiple joint pains, small joints predilection, jont deformities, morning stiffness and many more. You can refer to our section on this website and few other sites for more details.
She'll be required to take both DMARDs and NSAIDs together.
She can visit her physician again and ask for other more definitive tests this time like ESR, CRP, HLA B27, XXXXXXX anti CCP etc.
I hope this answers your query. You are welcome to ask more if you have any confusion.
Regards.



Good to have you back.
Calling them crooked would be rude. We can call them deformed and in my opinion they seem more rheumatoid than regular OA. At 53, people usually don't get these deformities by age related wear and tear.
But that's just me and my opinion. We need to confirm it before we jump to conclusions.
Thanks for choosing XXXXXXX
Regards.

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