About two years ago was the first time I began to notice swelling and pain in my proximal interphalangeal (PIP) joints in both hands. The PIP joints are the middle knuckle in each finger (not including the thumb). Although I had other symptoms, this was really the reason for seeing my primary care physician ultimately leading to a visit to a rheumatologist and a RA diagnosis. Early on, my rheumy ordered x-rays and the radiology report indicated some bone erosion in these joints. In spite of being seronegative for RA factor, this finding was enough for my rheumy to quickly begin disease modifying medications eventually leading to the use of TNF blockers (Enbrel, Cimzia, now Humira). Since then, inflammation has spread to the some of my metacarpophalangeal joints (MCP) at the bottom of each finger and to the wrist (and elbow, and knees, and feet…).
Inflammation of the PIP joints is typical in RA patients and can lead to permanent deformities in the fingers.[i] Joint damage can come on rapidly if RA is not treated. I vividly recall my first encounter with RA about 20 years ago. In the days before major disease modifying medicines, my neighbor had severe RA and his hands, fingers, and feet were deformed beyond use. He was such a gentleman and upon shaking my hand, quickly explained why his fingers were so deformed. Surgery scars were prominent on each finger. Surgeons went in and clipped the ligaments in a futile attempt to slow the deformity.
Because of this, I’ve kept an eye on my fingers. A few months back, my rheumy ordered another round of x-rays and the good news was that the radiologist noticed no additional bone erosion. But since I live with my fingers every day, it’s easy for me to notice slight changes. Several fingers began to bend towards the outside (called ulnar drift) and some are no longer straight but are twisting/rotating (see photos).
I can certainly rejoice in the fact that bone erosion in my fingers seems halted at this time. And I can’t complain because many RA patients have dramatic joint damage and deformity. I suspect that the use of TNF blockers has something to do with my case. Never the less, I can see the changes over time.