OpenHealth Q&A

Navigating a Complex Diagnosis: Bilateral Index Finger Sesamoiditis vs. Autoimmune Inflammatory Arthritis

For the past three years, I, F33, have endured persistent discomfort characterized by joint pain, inflammation, and stiffness. Initially affecting my left hand, my right hand has escalated to a similar, if not worse, state over the last year. My medical history includes a diagnosis of ADHD (managed with 5mg of Adderall twice daily and a 150mg dose of Wellbutrin XL), Autism Spectrum Disorder (ASD), anxiety, hypermobility, and a previous episode of guttate psoriasis, shingles, and Bell’s palsy in my early twenties. The onset of my hand pain can be traced back to a viral illness I suffered from starting in December 2022, during which I contracted the flu on two occasions, along with bronchitis and sinus infections. Since that time, I’ve been experiencing various symptoms, including: - Occasional malar rash - Intermittent low-grade fevers - Frequent feelings of unwellness and a sore throat - Moderate fatigue that has drastically impacted my daily routine, often resulting in extensive daytime sleep - Swelling and pain in my MCP joints, with morning stiffness lasting several hours. There are no days entirely free from pain, although the swelling tends to vary. - Other persistent issues include chronic constipation, temperature regulation problems, and a sensation of coldness in my fingers and toes, mild hair thinning, in addition to symptoms suggestive of mild postural orthostatic tachycardia syndrome (POTS) that began around the same period. I had an echocardiogram this year, which returned normal results. Importantly, I have consistently exhibited mild neutropenia and low white blood cell counts in blood tests since 2021, leaving me susceptible to illnesses that tend to linger. Furthermore, my life is often overshadowed by significant stress linked to processing challenges associated with being on the autism spectrum. I recognize that chronic stress might compromise my immune defense and contribute to persistent fatigue. While I have hypermobility, I have not received a diagnosis of Ehlers-Danlos Syndrome (EDS) or any related conditions. As a veterinary technician, my work heavily relies on my hands, and the pain I experience frequently hinders my performance. Even during extended breaks where I minimize hand usage, I observe no noticeable improvement in pain or swelling. I have consulted numerous specialists and have normal bilateral X-rays from 2023 and a regular MRI of my left hand performed in May 2024, which at that time was the only affected hand. A hand surgeon explored treatment options, including a cortisone injection, which proved ineffective. He prescribed topical diclofenac with no success, and his assessment suggested a diagnosis of sesamoiditis attributed to my hypermobility—an unusual occurrence for the index finger. His recommendation for surgery to remove the sesamoid bones is pending further evaluation. Recently, a six-day course of prednisone alleviated the pain but did not address the swelling. Notably, my index MCP joints are visibly swollen on the palmar surface. Palpating the area reveals significant edema, and while my left sesamoid bone appears elevated, the right does not. Tenderness is present when pressure is applied around the joint, though I experience sharp pain during finger flexion and extension, accompanied by a constant ache. Occasionally, when my symptoms intensify, my hands feel warm and exhibit slight reddening. During such flare-ups, I also encounter feelings of malaise and extreme fatigue. I remain skeptical about the sesamoiditis diagnosis and am anticipating an appointment with a rheumatologist to better explore the possibility of inflammatory arthritis. Previous tests have shown negative inflammatory markers, including ANA and RF, but I have not undergone blood work since August of last year. My symptoms have worsened since November, coinciding with the onset of fever-like symptoms. I believe an ultrasound might provide essential insights. Although I have contemplated potential hypothyroidism, all of my TSH levels, as well as B12 and vitamin D, have consistently been normal. After enduring this situation for so long without a definitive diagnosis, I find myself at a crossroads. I am eager to connect with anyone who may have encountered a similar case, as the hand surgeon's confidence in his assessment felt somewhat lacking. I am resolute in my decision not to undergo any surgical intervention without a clear diagnosis and exclusion of autoimmune conditions. Thank you for your support and insights.

Answers (1)

3/29/2025, 7:30:58 PM

OpenHealth AI

It sounds like you’ve been navigating a challenging journey with your hand pain and broader health concerns. Your symptoms and medical history suggest a potential autoimmune or inflammatory component, especially given the persistent inflammation and fatigue you're experiencing. It's completely reasonable to seek clarity and a concrete diagnosis before considering any surgical interventions.

Key Points

1. Complex Symptom Profile: Your symptoms—joint pain, swelling, fatigue, and skin changes—could suggest an underlying inflammatory or autoimmune issue.
2. Skepticism About Diagnosis: It’s valid to question the sesamoiditis diagnosis given the complexity of your condition and the lack of improvement with prescribed treatments.
3. Rheumatology Appointment: Meeting with a rheumatologist is a crucial next step to explore serious conditions like inflammatory arthritis further.

Explanation

The symptoms you describe, such as bilateral joint inflammation, morning stiffness, and systemic issues (like fatigue and low-grade fevers), align with possible autoimmune conditions. The autoimmune spectrum can include various diseases, some of which might not initially show positive markers in blood tests (like rheumatoid arthritis or lupus). Given that you experienced a flare-up of symptoms after recent viral illnesses, there might be a connection to an autoimmune trigger.

Mild neutropenia and low white blood cell counts can further complicate diagnostics, as they may make you more susceptible to infections, which can exacerbate symptoms.

Next Steps

1. Prepare for Your Rheumatology Appointment:

   • Symptom Diary: Keep a detailed record of your symptoms, including the intensity, duration, and any patterns you notice. Document your experiences during flare-ups, especially how they correlate with fatigue and malaise.
   • List Questions and Concerns: Write down your concerns about the current diagnosis and symptoms you've experienced. Clear communication can enhance your consultation.
   • Request Comprehensive Testing: Discuss potential tests that could explore autoimmune conditions more deeply, such as additional blood tests (e.g., anti-CCP, ENA panels) or imaging (e.g., ultrasound of affected joints).

2. Self-Care Strategies:

   • Manage Stress: Since stress can significantly impact your health, consider relaxation techniques such as mindfulness, deep breathing, or gentle yoga to help reduce overall tension.
   • Gentle Activity: Engage in low-impact exercises that don't exacerbate your hand pain. Physical therapy might also provide tailored exercises to improve strength and reduce stiffness.
   • Healthy Diet: Focus on a balanced diet rich in fruits, vegetables, omega-3 fatty acids, and antioxidants, which might help reduce inflammation.

3. Monitor Changes: Stay vigilant about any new or worsening symptoms, such as prolonged fever or changes in joint health. If your symptoms escalate, it may be necessary to seek immediate evaluation sooner than your scheduled appointment.

In summary, maintaining an open line of communication with your healthcare providers while actively participating in your care is essential. You have the right to seek a second opinion or further diagnostic clarity, especially with the complexity and persistence of your symptoms. Remember, you are not alone in this; connecting with support groups or communities can also provide additional understanding and solidarity.