Do I have rheumatoid arthritis?
Q) I have what I'm told is osteoarthritis but wonder whether it could be rheumatoid arthritis. It has been diagnosed simply by looking at my hands, in which the base of the thumb and the ﬁrst two ﬁngers are affected. The end joints of my ﬁngers are swollen and red. I've been told that this form of arthritis is hereditary and that my mother’s hands would be the same, however my 90-year-old mother’s hands aren't like mine. I've been told that a blood test isn't conclusive. I've researched the problem on the internet and it seems it can be difﬁcult to differentiate between these two forms of arthritis. The pictures I've seen of hands with rheumatoid arthritis look like mine. I don't have arthritis in my weight-bearing joints. Can you suggest any way of checking which form I do have? My main hobby is needlework, but as well as the pain, my dexterity is fast deteriorating.
Mrs PJ Redman Garstang, Preston, Lancashire (Winter 2008)
A) Experienced clinicians recognise the different ways that arthritis can present. In your case the pattern of joints involved is typical of osteoarthritis. The joints involved in osteoarthritis are at the base of the thumb, the tips of the ﬁngers and less commonly the middle joints of the ﬁngers. If necessary your doctor could conﬁrm this clinical diagnosis with an x-ray and blood test, but it probably isn’t necessary. Osteoarthritis can go through an inﬂammatory phase where it looks like rheumatoid arthritis and it's likely that this is happening with you at the moment. This will not last for ever and it's likely that eventually the joints will become painless, albeit with some deformity. There's clinical trial evidence that some of the drugs used for rheumatoid arthritis can help the inﬂammation phase but we rarely need to resort to this.