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What is the reason for pain in the finger joints every morning?

Saturday, 03 March 2007
Answered by: Professor Anand N. Malaviya
Consultant Rheumatologist,
A & R Clinic,
New Delhi
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Q. I am 39 years old. Couple of years back, I had an attack of a frozen left shoulder and was treated with steroids, after which I recovered completely. For the last 3 months, I experience finger joint pain in both my hands, early in the morning. I consulted a rheumatologist who said that my uric acid level was slightly elevated, but rheumatoid factor was negative. The doctor diagnosed the condition as gout. I am being treated with Zycolchin 0.5mg twice a day (morning & night) with an advice to have at least 3 litres of water. I am not diabetic. I am taking this medicine regularly, but I don't experience any improvement. Now, I have started getting this pain even when I take my afternoon naps. Am I on the right path?

A.  Your symptoms are rather typical and indicative of the presence of an inflammatory polyarthritis of rheumatoid variety. Presence of rheumatoid factor is not necessary for making a diagnosis of rheumatoid arthritis. The diagnosis is made on the basis of a set of clinical features that only a trained rheumatologist can decipher. I am sure you have not consulted a rheumatologist but possibly an orthopaedic surgeon or a physician not well trained in rheumatology. The reason for me saying so is that gout is never diagnosed by the presence of high uric acid but by the clinical history of acute explosive onset of a single joint involvement (almost always at the base of the big toe) with swelling and redness associated with severe pain usually starting at mid-night after a heavy meal or after a party with a lot of alcohol. The diagnosis is confirmed by the presence of monosodium urate crystal demonstration in joint aspirate examined under polarised light microscopy. This acute pain usually subsides in 7-10 days on its own but can be dramatically controlled with a category of drugs called NSAIDs. Zyloric, if given during an acute attack of gout increases the severity of attack. Therefore, it should never be given during an acute attack. On the other hand NSAIDs given during acute attack dramatically relieve the symptoms. Obviously, you do not have gout as none of the above fits with the symptoms that you have described! Zyloric is definitely not the drug for you. I strongly recommend that you consult a trained and experienced rheumatologist immediately for getting correctly diagnosed and treated.

A.  Your symptoms are rather typical and indicative of the presence of an inflammatory polyarthritis of rheumatoid variety. Presence of rheumatoid factor is not necessary for making a diagnosis of rheumatoid arthritis. The diagnosis is made on the basis of a set of clinical features that only a trained rheumatologist can decipher. I am sure you have not consulted a rheumatologist but possibly an orthopaedic surgeon or a physician not well trained in rheumatology. The reason for me saying so is that gout is never diagnosed by the presence of high uric acid but by the clinical history of acute explosive onset of a single joint involvement (almost always at the base of the big toe) with swelling and redness associated with severe pain usually starting at mid-night after a heavy meal or after a party with a lot of alcohol. The diagnosis is confirmed by the presence of monosodium urate crystal demonstration in joint aspirate examined under polarised light microscopy. This acute pain usually subsides in 7-10 days on its own but can be dramatically controlled with a category of drugs called NSAIDs. Zyloric, if given during an acute attack of gout increases the severity of attack. Therefore, it should never be given during an acute attack. On the other hand NSAIDs given during acute attack dramatically relieve the symptoms. Obviously, you do not have gout as none of the above fits with the symptoms that you have described! Zyloric is definitely not the drug for you. I strongly recommend that you consult a trained and experienced rheumatologist immediately for getting correctly diagnosed and treated.

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