Why are my hands getting stiffer despite RA treatment?

Question

Hello doctor,

I am 47 and have rheumatoid arthritis, and over the last few months, my hands have become so stiff in the mornings that even brushing my teeth takes forever. I keep wondering, can rheumatoid arthritis keep damaging joints even when the pain is not that bad?

Some days the pain is mild, but my fingers still feel swollen and weak. I have not missed any medications, so I am really confused why things seem to be getting worse again.

My family thinks I am overreacting because I am still able to work, but I can tell my hands are not the same anymore. I do not know if my treatment has stopped working or if this is just part of the disease progression.

Kindly help

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

You have to get a full check-up of your rheumatoid arthritis condition by an expert rheumatologist, as pain is not the only criterion for evaluation of disease activity, and progressive swelling, limitations in range of motion, and joint destruction by radiographic studies might indicate an active disease that requires urgent intervention, or we are risking irreversible joint erosions and deformities.

A thorough examination of your joints, coupled with new investigations and imaging, will help paint a clear picture of whether your problem is disease activity or a secondary cause.

In case of active disease not responding to conventional therapy, biological therapy such as anti-tumor necrosis factor (anti-TNF) is the next step and can help alleviate the stiffness and limitations, but it usually requires some time to work, so starting Prednisolone at 20 temporarily with them can help bridge the therapy period.

Investigations needed for biological therapy:

Complete blood count (CBC).
Erythrocyte sedimentation rate (ESR).
C-reactive protein (CRP).
Alanine aminotransferase (ALT).
Aspartate aminotransferase (AST).
Serum creatinine (Sr Creatinine).
Hepatitis C virus antibody (HCV AB).
Hepatitis B surface antigen (HBsAg).
Human immunodeficiency virus antibody (HIV AB).
Tuberculin test.
Chest X-ray.
Hand X-ray.

Biological therapy, Methotrexate 25 milligrams weekly, Folic acid 5 milligrams weekly, Prednisolone 20 milligrams daily for two weeks, then start gradual withdrawal, calcium and vitamin D supplements.

Follow up after laboratory results before starting biological therapy, then every three months during management.

I hope you are satisfied with my answer. For further queries, you can consult me at iCliniq.

Thank you.