Any thoughts welcome

This is a photo of my friend’s right thumb which has been swelling for over a year and has been painful since the end of last year. She is currently waiting for a referral to the Hand Clinic. GP has told her that x-ray results showed ‘severe arthritis’. She has fallen on that hand a few times in the past and thinks that may have damaged the thumb.

She also has intermittent swelling & pain along the top of her right foot and a long history of fatigue which has always been dismissed. Unlike the doctors, I’ve known her for 40 years and if she says she’s very tired, then she most certainly is. If she uses the word pain, then I suspect it’s really quite bad pain, she’s a very stoical person.

She is having to wait a long time for referrals from one place to another and it seems like nobody is even considering joining any dots.

Main reason I’m interfering is that this thumb seems, at the very least, to be doing rather a good impersonation of Mutilans. I think she should push for an appointment ASAP if there are further delays.

I’d be great to hear your thoughts.

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From the picture it looks more like a heberden or Bouchard node. But your description sounds more like an inflammatory issue. Of course, both could be correct. Either way, she definitely needs to see a rheumy. Can she go the private route?

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My mom has herberden nodes on every finger joint and they look more bony. Mine are just on a couple finger joints. You mentioned your friend’s thumb is painful…my mom and I don’t have much pain in our herberden nodes—they ache a little at first, but then they settle down and just look ugly. I’d say your friend’s swollen thumb is something other than that—definitely inflammatory. Has she been checked for RA? Here’s a picture of one of mine for comparison…

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Thanks so much @Stoney & @Grandma_J, really very helpful. Grandma J, your top finger joints are very much like mine, though her swelling is hard rather than fleshy.

My friend is reading replies & will consider joining up if necessary.

First your poor friend. To have pain and fatigue issues dismissed like that for so long must be so demoralising. Has her GP asked the radiologist to identify what sort of ‘severe arthritis’ the x-ray showed. It does look like mutilans sadly, from what I seen other people suffer. And the history you’ve described does look like it might be ‘inflammatory’ in nature. Has she had any of her inflammatory markers checked blood test wise? Does she have any history herself or family wise of psoriasis? Or Rheumatoid? Those thumbs nails look pretty normal. What are the rest of her nails like?

Here’s what I’d do in her situation instead of waiting for people to join up the dots. First ask her GP for a referral to a rheumatologist and to find out how long that’s going to be. Lots of areas in the NHS still have the 6 week urgent referral. If her area doesn’t between you and her you can find out which rheumy is properly ‘interested’ and ‘experienced’ in PsA/inflammatory arthritis depending and see then if they do ‘private’ work and get a private consultation referral organised by her GP. The cost is fairly doable under £500 and at least that private consultation might start answering some questions.

Meanwhile I’d advise continuing to wait for the hand surgeon referral. Some of those are pretty good at diagnosing inflammatory arthritis too. Only some mind but worth the chance. And anyway they will know and see what’s happening with that thumb too.

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Thanks Poo.

Can’t speak for my friend who is on her way home now, but I’m sure she’ll be very interested in your reply which I think echoes some of my own suggestions.

I think I paid under £200 for my one private appointment at Bath, maybe a little over, but yep, totally agree it’s a good option.


I had a big swollen thumb a few years ago (harbinger of things to come?) and the hand surgeon diagnosed trigger finger, two shots of cortisone two weeks apart did the trick so there was never any follow-up. I didn’t have any other symptoms so I guess it makes sense that they didn’t talk to me about inflammatory disease.

I hope she can get as much information as possible sooner rather than later!

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Thanks Magpie. Did your thumb look like the one in the picture?

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Similar… it was more swollen on the other side of that knuckle (away from the fingernail) but about that size.

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    June 11

Similar… it was more swollen on the other side of that knuckle (away from the fingernail) but about that size.