Q. What causes swelling and pain in DIP joints?

Answered by
Dr. Naval Mendiratta
and medically reviewed by Dr. Divya Banu M
This is a premium question & answer published on Aug 19, 2019

Hello doctor,

I have had pain and a tiny bump on right pinky (DIP) for over six months, only when I touch it. Now I have slight stiffness in two other DIP joints and one PIP joint (same R hand which I use a lot on the computer, maybe two hours a day). Also one DIP joint other hand. It got much worse with my allergies this month, and I have had a lot of stress in the past few months.

I also have pain in my left toe and possibly have Morton's neuroma between toes 3/4. But I have terrible flat feet and was walking a lot for three weeks with sandals. I have been home for three weeks and it is not better. So, I went to my doctor and he thinks I have rheumatoid arthritis. He says it starts in the feet and hands. Blood workup is totally normal for RA factor and inflammatory markers. This is causing me severe anxiety. He did not take X-rays but says he can see changes in my hands. They look the same to be as I am petite and have always had bony hands. He is a rheumatologist but did not even touch my hands to examine them. I have had no fevers, tiredness, anemia, etc. Just now a lot of anxiety over this.

Can this be allergies with some slight osteoarthritis? Stress inflammation? Also, I am starting menopause as I am 48 years old, no period since last month. Hormones? I do have a slightly swollen gland under right ear and right side of throat is sore from postnasal drip, also had cold sores in the mouth. I do not know if a virus can affect this also. I will upload the blood report.

Dr. Naval Mendiratta



Welcome to icliniq.com.

Well, as per your clinical history and symptoms it does look like nodal osteoarthritis of the hands. My point in favor:

1. DIP joints are never involved in rheumatoid arthritis. If they are inflamed we have to think of alternative diagnosis. Either OA or psoriatic arthritis. But from your history, it seems more like nodal osteoarthritis with Herbedens nodes and Bouchard's nodes.

2. If it was rheumatoid even if seronegative ESR and CRP should have risen but they have not. So, it is unlikely there is any inflammation going on.

3. As per your feet, it looks like you developed plantar fascitis. Would recommend you to start wearing sports shoes and do some compressions in a hot water tub. That should help.

Apart from it, the swollen gland may be due to a viral infection only which I am hoping should settle in due course. But yes, if you need a final confirmation, best is to ask for an ultrasound of hands and feet that would tell us if there is inflammation or not as X-rays may not pick up early changes.

Investigations to be done:

Ultrasound of hand.

Probable diagnosis:

OA of hands.

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Thank you doctor,

The doctor had said that I can start to have RA without positive blood results, that is why I was no nervous. What is your comment on that?

Dr. Naval Mendiratta



Welcome back to icliniq.com.

Well, yes that is a possibility. So, we depend on our clinical findings. That is if there is swelling and tenderness along with redness in the joints we know it is inflammation and most importantly pattern of involvement. So, from your history DIP joints go against RA. A lot of times osteoarthritis gets confused with rheumatoid arthritis and that is happening in your case.

But yes, for your and your rheumatologist satisfaction, you can request him for ultrasound or MRI of hands. If there is inflammation, there it makes sense to start treatment. With normal inflammation markers, negative arthritis test, and not very significant inflammation clinically, we should have some evidence to start you on long term DMARDs (disease-modifying antirheumatic drugs).

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