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Delicate pip and dip joints connected to DD
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01/03/22 11:17
markharr 
01/03/22 11:17
markharr 
Delicate pip and dip joints connected to DD

I’m a 60-year-old guy who has lived in Sweden for 30 years, so hands exposed to plenty of cold weather. I’ve always been fit and active.
This summer I suddenly got DD nodes in both hands, on palm towards ring and middle finger.
They grew over about 3 months, during which I had a lot of general hand and finger pain, itching and pulsating, enough to keep me awake at night. Also hard growths beside the tops of my knuckles, and softer growths on the sides of some finger joints (pip). I woke each morning with very stiff ‘claws’ for hands that slowly loosened up, but eventually had trouble with shoelaces and buttons even during the day. No redness or warmth or oedema. Thumbs were OK. My local doctor excluded inflammatory diseases with xray and blood tests, and dismissed me with “Diagnosis : pain in hands. No notable clinical signs. No follow up needed”. Pain is now bearable, but I avoid any hard work with my hands, and use wrist hooks at the gym.
So far sounding like many stories here, even though I understand that pain is an unusual feature of DD.
But since the first episode settled down, I’ve found that my finger joints (pip and dip) are very delicate, and even light manual work like gardening, changing car and bike tyres etc are not only painful, but if I accidentally stress them too much I cause long-term damage, so that I now have 3 joints (ring pip, index pip and dip) that I need to keep taped up when they are not completely resting, to avoid approaching a 90 degree bend which is extremely painful. Two more are on their way to needing sports tape. I have no nodes or strings near these joints, but a slight thickening on the lateral aspects of some of those joints (not boney, and don't look like what I find about Heberden's Nodes). I don’t think I have Garrod’s pads either.

It’s this delicacy of finger joints that I haven’t found anything about in my online reading, so my question to the forum is if anyone else has these symptoms of weak finger joints, and if so, how they deal with them ?
And I wonder how careful I need to be to avoid permanent damage.
I know long-term cold exposure is implicated in the disease, but what about short term ? Will a day working in -10 C accelerate the problem ?

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01/03/22 11:41
spanishbuddha 

Administrator

01/03/22 11:41
spanishbuddha 

Administrator

Re: Delicate pip and dip joints connected to DD

Hi Mark

The photos do show signs of DD in the palms and at least one of the fingers. I would say get another Dr. or at least ask for a referral to a hand specialist. Probably would be a surgeon but you're not looking for surgery just a good diagnosis, and suggestion s for treatment. The problem with the joints sounds like early signs or rheumatism or even arthritis, or just minor strains with wear and tear of joint capsule, ligaments, pulleys, although you say inflammation has been ruled out by blood tests. I would hope a hand specialist could run more tests to isolate or differentiate what's going on and suggest a path forward, physio, massage, NSAIDS, etc. A physical exam can help find DD nodules or cords and their location or any impact on the joints. I have some early arthritis in a couple of finger joints and use ice, heat and topical application of voltarol to ease the discomfort, and occasionally a compression glove overnight. I am fortunate in being able to cease the activity causing my joint problems, piano or tennis, until they recover a bit. I can't say about working with hands in very cold temperature. Presumably the tendon and joint lubricating fluids are less effective. Do you wear gloves that are able to provide warmth and protection? Maybe some electrical or chemical hand warmers, gloves, would help? I have seen these but have no direct experience of use.

Best wishes SB

01/03/22 14:26
markharr 
01/03/22 14:26
markharr 
Re: Delicate pip and dip joints connected to DD

Hi,
Although the joint problems sound like arthritis or rheumatism, there is no sign of inflammation, and what I find odd is the timing - that I went from having strong, healthy hands to not being able to do jobs around the house in the few weeks that my DD was developing rapidly. It seems they must be connected, yet I find no-one else with this combination.

I do indeed use gloves and electric heaters when I can, but sometimes it's not practical, so it would be good to know how important it is to avoid, say, an afternoon fixing a car engine in the cold. Whether it's just another day added to 30 years of cold exposure, or if once DD has developed, single incidents can trigger rapid deterioration, like a single incidence of overwork reportedly can.

Bypassing the official medical system here is very difficult. There's an option for "patient-written-referral", but it needs to be written very carefully (it's judged as if it came from a doctor), and so I'm trying to gather information here before doing that.
Mark

01/03/22 15:40
spanishbuddha 

Administrator

01/03/22 15:40
spanishbuddha 

Administrator

Re: Delicate pip and dip joints connected to DD

I would be dissatisfied, as you seem to be, with the "Diagnosis : pain in hands. No notable clinical signs.". Given that there are clinical signs of DD just from photo's, and even though your local health policy for that might be wait and see (?) the other accompanying problems with your hands that are atypical for DD and are inhibiting your ability to work, further counter the opinion "No follow up needed”. and seem like a good case for referral to a specialist. There are specific markers in the blood for RA and I would confirm or otherwise your blood tests looked at these. As a last resort I would seek a private paid for consultation, if that is possible in Sweden, to gain grounds for further referral within the health system.

Edit to ask if you have any signs of Raynauds, even moderate? I imagine that would be obvious in your winters?

Edited 01/03/22 15:46

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