Pain without swelling/painful to type

I had two questions:

Does anyone else have pain in the joints without swelling? I always kind of felt like my old rheum's would pish posh my pain because my joints weren't swollen (although they do occasionally swell, sometimes I just ache without the swelling, or the joint is tender, but not really swollen). Anyway, I was kind of curious if anyone else experienced that.

My other question was if anyone else has experienced pain when typing - mainly in the finger joints and the finger tips is where I experience it. And it's not a great thing since my job pretty much consists of me sitting at a computer all day typing (I write courseware). Currently working with my new rheum to manage the pain, we've switched to a new NSAID (from naproxon which wasn't working at all anymore to 40 mg of Diflonec sodium, and then up to the 75mg - twice daily, on top of my MTX (15mg?)). Current rheum doesn't want to up my MTX dosage until she exhausts the other alternatives since the MTX gives me awful fatigue. It's not terrible and I can usually push through it (not sure if I just have a high pain tolerance or I'm just used to it, or if its really not that bad), but by the end of the week I'm exhausted and weepy from constantly ignoring the pain. If anyone else has experienced it and knows of ways to alleviate/work around it... I'm open to ideas.


Yes! I can have intense pain without much swelling....I have been told in relation to my Psoriasis and PsA that I am atypical in that my patterns of Psoriasis and pain are not typical.

My pain is without swelling. There is pain in most of my joints but no visible swelling. Sometimes I can feel heat from my hip and it feels like my underwear is tight on that side. I take 75 mg diclofenac twice each day. I take sulfazine. Have been without the diclofenac since Monday. Just took my last dose of the other meds. I can really feel it today. Having trouble getting my meds refilled. My finger tips get really sore. When I am on my tablet it hurts also, just to point at the screen. My rheumatologist is really good about knowing that I am in pain without swelling. When I first saw him I did not have any noticeable swelling. He told me to take my meds faithfully but the pharmacy has faxed him for refills with no response. I have called his office. It is frustrating but maybe it is ok to go a few days without meds. He only refills on Fridays.

I have never experienced any real swelling. My fingers itch sometimes. They may be a little inflamed today. Around each joint I am burning and aching a little. I never had psoriasis. It was found in my toenail. I also take doxycycline because mine was triggered by c diff, an intestinal infection.

Is swelling inevitable? I am newly diagnosed. Have only been treated since October. I see pictures of swelling on here. So far, have had nothing like that.

sunshine: Thanks, sometimes I need confirmation that it's not "all in my head" (had a few of those doctors growing up, if not I'm sure my PsA would have been caught much sooner).

mom5: I'm not really sure if swelling or anything is inevitable. I think it might depend on the progression of your individual disease, quality of treatment, etc. Though I'd be really p.o.'d if my doc made me wait a week with no meds - that doesn't help with its effectiveness. If this is a general policy of his you may want to make sure to always have your refills ordered a week or two before you run out (or switch docs if you can - I know it can be hard; until recently I lived in a town with no rheumatologists at all and had to drive two hours to see one). I hope you have better luck with that!

Thank you. I had assumed he would give me a prescription Monday. I will have to be more aware about when I need refills. This office is much different from the other doctors that I have. I may have not been diagnosed for a long time, if at all, if I didn't refer myself there. It is nice to know others have pain without swelling. At times I wondered how they know I have PsA for sure. No psoriasis except for my toenail, no swelling, Since being treated I am in much less pain. There are days that are worse than others. My elbows are especially sore tonight. Not swollen at all though. There are many rheumatologists in my town. My case is kind of difficult which is why I chose this rheumy. Maybe without the swelling the disease is milder? I really don't know.

I did a blog post a while back about ring splints. I am currently wearing one on my left index finger PIP joint, and on three DIP joints. I’ve had damage to my fingers from the disease. What’s interesting to me is that they haven’t been inflamed for quite some time, yet the more obvious damage is more recent.
The ring splints keep them from hyperextending, and therefore lower my pain levels. At some point they may require surgical correction, but I’m pretty happy at this point. And they look pretty.

This is a picture of the splints. I can’t type without them or do much of anything.
445-image.jpg (1.47 MB)

Stoney: I hadn't thought about hyperextension, I'm sure I do it when I type all the time.

Yes, I get joint pain without any visible swelling. Usually it will appear slightly red near the joint but not swollen. I really don't think the general types of pain and swelling that the doc's view as a symptom are the only ones. There are so many other symptoms they don't seem to pay attention to which are significant.

I found the PsA clinic I went to at Toronto Western paid attention to all the little symptoms that my regular rheumy doesn't.

I was first diagnosed with an AI condition in July 2011 after having elevated CRP, Rheumatoid factor and bursitis in four places in my shoulder. I didn't have visibly swollen (to a doctor) areas until July 2013 when I "finally" got dactylitis in my toes. Before 2011 I had tendonitis and nerve sensitivity in various areas. So, I have had tons of pain without the "hot swollen joints" they love to look for/ask about. Its enough to make you feel crazy when you know there is something wrong but no one else seems to see it. I have always had really long slender fingers, when my thumbs swell, I can tell, but my doctors seem to think they look normal. Even though it was a major pain (pardon the pun) I was kind of glad to finally get sausage toes so I could get a final diagnosis of PsA instead of possibly RA but who knows?

I have pain without swelling daily, but also have gotten massive swelling during flares, but not all of them.

As far as typing goes - I find that compression gloves help me a lot, as does my soft spica splint (gives support to my thumb joint). I've heard great things about ring splints as well.

I'm glad my rheumatologist treated me even though there was no swelling. Maybe he saw things I didn't. I knew there was something wrong. I thought I had fibro or reactive arthritis. It was a surprise that it is PsA since I never had psoriasis symptoms. On the second appt I showed him my toenails without polish. The nail PsA was found then. I feel like I have enthesitis. Pain where the tendons attach. We haven't discussed it but it sure does feel like it.

Absolutely, I have pain and damage in my hands and fingers with occasional mild puffiness and little to no redness. I also do not have any nail involvement or skin disease. I have trouble typing and it seems to wax and wane. I have lost grip strength and often drop things and that is very frustrating. I use compression gloves, heat gloves and pain meds to manage it. Before I was taking MTX and my hands were pretty awful. Now I am on weekly Humira and the stiffness and pain is generally better. Not perfect, just better.

HoneyBunny, I also lost my grip strength. I began dropping things. When I cook now, I burn my hands all the time. Maybe it is me being careless with the fatigue. My hands will get puffy and a little red looking. My typing trouble waxes and wanes as well.

I also have grip problems, I've asked both my recent and previous rheum about it and their only comment was to use a stress ball or theraputty to try to regain some of the lost strength. (The theraputty actually looks pretty neat, but I've never gotten around to getting any). I knit or crochet pretty much every evening because I don't want to lose that dexterity, it seems to help a little bit to keep active, but sometimes I only do a couple rows then give it up for the evening because my hands hurt. I use an ergonomic grip for my crochet hook(s) that's pretty awesome and keeps me from having to contort my hand. (see picture below).

I don't know about mtx but with the sulfazine if I don't drink enough water it is terrible. The sulfazine really dries you out. I didn't know about the NSAIDS though. I was never much of a water drinker but now I'm trying to make sure I drink enough. The information sheet said to drink two quarts of water per day with it. Drinking orange juice also helps me. I take folic acid as well. My rheumatologist told me to take vitamin D. It seems to help with pain. I think MTX is out of the question for me right now. I have a stone or something causing my liver enzymes to be elevated. My gallbladder was removed but something is still wrong with my biliary system, so the rheumatologist said. Drinking water is very important for me. If I don't I get so tired I almost fall over.

I just read tntlamb's post. Very interesting. thank you.

I use the theraputty when I can. I got it from PT. It helps when I don't hurt too much to use it. Some days it's too painful to use the putty. Frustrating... makes me appreciate the on again off again nature of PsA. Hands hurt one day then it is my feet or somewhere else. Maybe you could modify how you use your hands more and reduce the strain. Hope you feel better!

I did...thanks! I need to work on drinking more water! :)
sybil said:

Just a quick thing re. your fatigue .... have you seen what tntlamb has been saying about fatigue & the importance of drinking a quite specific amount of water when taking NSAIDs / Mtx? It's on the thread 'Newbie Question'.