By Steve Mora MD
Orange County Orthopedic Surgeon
Do You Wake Up with Swollen and Stiff Hands?
When patients come to me for evaluation of knee, elbow or shoulder joint pain I will do a basic screening for rheumatoid arthritis. The question I ask is whether or not they experience morning stiffness of their hands. Morning hand stiffness is a classic early sign of rheumatoid arthritis. The stiffness and swelling of the hands will usually last more than an hour after waking up. It tends involve both hands. The joints that are mostly affected are the ones that connect the fingers to the hand and the wrist joint. I will usually ask the patient if they simply have difficulty putting on their rings in the morning.
Using this very simple screening question I have diagnosed many patients who have come to see me for large joint pain. These patients had no idea that they had a serious progressive and potentially disabling problem.
Other common symptoms include significant fatigue, multiple joint pain, redness or deformity of the small joints of the hand, fevers, and weight loss. Other risk factors include being a female aged 40-60.
If they answer positively, I will send the patient for screening blood tests.
Screening labs include; elevated erythrocyte sedimentation rate (ESR, or sed rate) or C-reactive protein (CRP), which indicate systemic swelling. Other common blood tests includes rheumatoid factor (RF) and anti-cyclic citrullinated peptide (anti-CCP) antibodies. I also screen for other inflammatory conditions including Lupus (ANA) , Gout ( Uric Acid) and Reiter disease, Ankylosing Spondylitis (HLA-B27).
The interesting thing about x-rays is that they are usually negative. The main reason is that rheumatoid arthritis is a disease of the joint lining. The lining contains synovial cells. Rheumatoid arthritis is a disease of the lining and not a disease of the bones; this is what makes it different from osteoarthritis. Therefore early cases will not show any abnormal changes on plain x-rays.
In some cases a magnetic resonance image (MRI) might show swelling around a joint or inflammation within the bone.
If the patient’s labs are positive I will send the patient to see a rheumatologist.
If a patient’s labs are negative but they have solid signs and symptoms of rheumatoid arthritis I will still send the patient to see a rheumatologist. There are inflammatory conditions, very similar to rheumatoid arthritis but different in that screening blood tests are negative (sero negative).
So the main point of this blog is to educate folks about some of the most common signs of rheumatoid arthritis, common screening labs and the need to see a rheumatologist even if the labs are negative; specially if there is morning bilateral hand pain and swelling.
The good news is that often times when the diagnosis is made early, treatment can be effective. The aim of treatment is to not only reduce the joint pain and swelling but also to decrease the likelihood of joint deformity. Treatment does not always include chronic prednisone use, i.e. steroids. I know that this is a big concern for many patients.
Thank you for your time.
About Dr Mora
Dr. Mora is a native of Orange County. He graduated from Anaheim High School in Orange County CA. He completed his training at the UC Irvine where he finished in the top of his class with AOA Medical Society honors. He completed his Orthopedic Surgery training USC. He completed an extra year of training with a Sports Medicine, Cartilage, Shoulder, and Knee Fellowship at Santa Monica Orthopaedic and Sports Medical Group. He is currently practicing Orthopedic Surgery in Orange County at Restore Orthopedics and Spine Center.
Dr. Mora’s practice focus on Sports Trauma, Knee Arthroscopy, Shoulder Arthroscopy, Hip Arthroscopy, Elbow Arthroscopy, and Cartilage Restoration of the knee. He sees athletes of all levels including professional soccer and UFC.
Dr. Mora’s family heritage is Peruvian. He speaks fluent Spanish.