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Janice, I also have had problems for several years with arthritis in both thumbs. I saw an orthopedic physician, who said I had bone spurs near the base joint on both thumbs, in addition to some arthritis. I started wearing a Mueller brand thumb brace at night, which keeps the thumb immobile during the night. Before putting on the brace, I rub in some Voltaren, which is now available over-the-counter, on the thumb and the hand area around the thumb. After three or so nights of this, the pain went away. I also Googled âexercises for the thumb,â and in the morning, after removing the brace, I gently moved and stretched the thumb as recommended in the exercises.
I think part of the problem was poor technique, and I was careful when playing not to stress the thumbs. In a few weeks, I was able to play normally again. I still have occasional flare-ups of the problem, in one hand or the other, and when that occurs, I again use the Voltaren and the Mueller brace for two or three days at night, and it goes away. At this point, I am only having problems about once a month or so, sometimes in one hand and sometimes in the other, and I have been able to solve it each time by applying Voltaren and wearing the brace for two or three nights in a row.
As some others have commented, you probably should see an orthopedic to see if anything specific shows up on x-ray, but I have been able to solve my discomfort by using the method described above (which, by the way, I came up with on my own). Good luckâI know this can be frustrating. Terry R.
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Terry Readdick Iâve also found Voltaren topical diclofenac to be the most effective treatment for my own thumb/basal osteoarthritis and elbow epicondylitis. In the USA you can now get Voltaren 1% over the counter, but in Europe you can get 2% which is da bomb.
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A few years ago, in my 50s I had rapid onset and quite symmetric pain in a couple of knuckles of both hands. I also had some in the joints of a couple of toes, and had been having painful episodes of tendonitis in my wrists on and off for several years. I had gotten to the point of steroid injections in my wrists and a doc starting to offer carpal tunnel surgery, which I had put off. With the symmetrical knuckle arthritis I was immediately skeptical that this was not "wear and tear" or osteoarthritis, as there was no injury and both hands had similar onset. I am a physician, and surgeon, and it was a threat to my career as well as to playing the piano of course. I had testing done with a rheumatologist, and was diagnosed with an autoimmune condition. I hav learned much since, including that I carry a gene marker I inherited from my mother, who also has suffered but was never diagnosed, and I have two nephews with the genetic trait HLA-B27 who have been very affected by the same spectrum of disease starting much younger. There are a few different autoimmune arthritis conditions, such as psoriatic, or spondyloarthropathy (in my case) - a version of ankylosing spondylitis that goes after the limbs more than the spine. Bottom line, if it is episodic, multi-joint, and even symmetric without some injury to correspond you may have an autoimmune condition. It can have onset mid to late in life. Something in your diet can become a trigger of flare ups. I had to go gluten free, and also low sugar. And I know, being gluten free can be the butt of comedy these days, and ten years ago I had no problem with gluten, but now I have joined the ranks that have to keep strict gluten free. If I break the rules I get burning pain in knuckles and the tendonitis in my arms flares up. Correct diagnosis of an autoimmune disease was the ticket for me, now I am on Enbrel which partly suppresses the immune system, and I am keeping busy on the piano and in the operating room. Beware also, you should hope for treatment to shut it down before it is visible on an x-ray, because by then you have real permanent joint damage. You need a provider that can work with you even if they can't see it on an X-ray, carefully testing, being willing to try treatments, and not wait for radiographic damage in the joints. Good luck. Hope my story can help.
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Dale Reynolds Iâm curious about the effect of gluten on your HLA-B27 spondyloarthropathy. If I may ask, would you be identified on a routine laboratory screen for celiac disease as positive? Are there more sensitive markers that are not part of the routine serological screening panel? Any symptoms of gluten enteropathy? Iâve often wondered about the role that that gluten might play in inflammatory conditions in individuals who escape clinical notice by having no enteropathy and who are negative on a routine laboratory screening panel for celiac disease. Havenât done a recent literature search, though.
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Michael The gluten sensitivity of celiac disease is a different spectrum of disease, and those that have it are often exquisitely sensitive to gluten, even more so and with more serious consequences than what I deal with in my arthritis/tendonitis condition.
Some arthritis conditions (and even eye inflammatory episodes called uveitis) are made far more likely in some individuals by having the HLA-B27 gene, which is passed on as a dominant gene, e.g. if your parent has one copy of the gene at the HLA-B locus, they will pass it to half their kids. It is easily tested for, often by sending a blood sample to a regional lab instead of the local lab service. People with a marker such as mine also have their own unique immune history. The immune system is to a very large degree affected by the cumulative immune experience of the individual so for example identical twins may not have the same amount of arthritis, or have it in the same parts of their body even with the same inherited genetic predisposition.
In my case, I have robust healthy intestinal function which is not stirred up by eating gluten, but I get painful multi-joint arthritis flareups, even on immunosuppressive treatment like Enbrel, when I cross the line by forgetting to check labels for example, and have a gluten-containing food. Something unique to me now lately is that I am also very sensitive to mammal protein sources, so I can have fish and chicken, but no pork, beef, or dairy. That is an example of unique sensitivities that I have acquired since middle age onset, and my condition would be destroying my knuckles right now if I wasn't in a modern medical treatment world plus making significant dietary changes.
When I was in my 20s I could eat anything. I started with plantar fasciitis (tendonitis on soles of feet) in my 30s which started with a roar, putting on my knees in my apartment for the first month. The plantar fasciitis I still have, and have worn inserts in my shoes for over 30 years. I started with wrist tendonitis in my 40s which I still have. I became gluten intolerant and got actual arthritis in neck, back, hands and feet in my mid 50s, and finally got diagnosed and under treatment with Enbrel with a rheumatologist after failing lesser medications. Now for the past couple of years I am very dairy and mammal protein intolerant. My disease keeps getting more aggressive unfortunately.
My experience of evolving autoimmunity, made more likely by my genetics, is experienced by others as well and can end up being quite unique.
The class of medicines called DMARDS (disease modifying anti-rheumatologic) are a rapidly expanding class of meds that have become the area of expertise of rheumatologists, GI docs for celiac, and some internists who try to keep up as well. Many of the ad campaigns for expensive meds on TV in the USA these days are for these medicines, for a variety of diseases.
My message is that it is not 1960 anymore, and powerful treatments are out there. Yet in my own clinical practice I still see older folks mostly who are suffering major auto-immune joint damages and are not being offered these more advanced medications.
Hope these comments can help.
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Dale thanks for taking the time to write up your experience in such detail and so beautifully. It is the first time any knowledgable person has described to me the evolving interaction of dietary allergen exposure with an HLA-B27 spondyloarthropathy. When I looked into that about 10 years ago I did discover a lab in the USA offering very extensive serological panels for allergen sensitivity that included levels of detail like mammalian proteins etc. I spoke to a representative, and the laboratory was indeed legitimate, but the medical utility of its products was at the fringe of medical practice, and never covered by insurance. I had hoped to attach a URL for your interest, but alas I was not easily able to identify the lab when I did a search.
I suspect that the ease and falling costs of whole-genome sequencing may facilitate more specific and accurate differentiation of rheumatological diseases earlier in the course of disease.
I wish you the best in gaining ever improving control of your condition for your professional activities, piano playing (and general happiness!). I can see that you have good consultants, and have great insight into the effects of your diet.
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Dale I ran across the lab that does the very detailed allergy, autoimmunity serologic testing, in case it is interesting to you:
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Hi, Janice. You must be overwhelmed with advice by now but here is one more. I have Raynaudâs Disease, which means my hands are always cold and the fingers become purple and inflexible. I am frustrated by the many trills in Schubertâs 960 and canât use my thumbs, which are arthritic, leaving only the others to compensate (and not very well). I sometimes resort fo playing in surgical gloves with the tips cut off or even therapeutic gloves for the thumbs. Of course these are awkward but offer an obstacle to my tendency to want to race and encourage a more supportive hand position. Recently, I have found a product I use to both warm and stimulate my hands and fingers called iReliev (no âeâ after âvâ). It annoys me to have to take the time from that allocated to practicing, but helps reduces my frustration at the keyboard. Most of my hand problems are caused by sports and gardening injuries to my shoulders; and having given up my primary instrumentâviolaâbecause of these injuries, I am determined not to abandon the piano. There are many good suggestions in the commentary which I will also investigate. All the best to all of my fellow sufferers. The fact we are still playing is testimony to our perseverance!
