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Can COLITIS cause swollen stiff finger? NSAIDS and TYLENOL.

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Hi. I am a 37 year old female with a history of colitis. For the past month, my right pointer finger has been painful and is swollen from above the middle joint to the joint closest to my hand. There is no sign of infection (no redness, warmth, fever, etc), and I don't remember hitting or injuring the finger. I had x-rays done, and the report states: There is soft tissue swelling about the right index finger PIP. There is no fracture or dislocation. Joint spaces are maintained. There is no osseous lesion. There is no periosteal reaction, cortical defect, or focal osteopenia seen.

It has been over a month and it is still swollen and painful (see attached photo). The finger is stiffer and hard to bend in the morning when I wake up, but is still somewhat stiff, painful and swollen throughout the day. The pain is worst when I try to bend the finger.

Besides this finger, I have noticed that my other fingers and big toes feel stiffer and hurt (never used to be an issue). I have also developed a few red raised bumps on my scalp near the hairline (see attached photo). There are a couple of these bumps on the left side and a couple on the right side. They are not pimples, and have been there for at least a week. I haven't been bitten by any bugs.

I can't take NSAIDs, and Tylenol hasn't helped the pain or swelling. I tried a short course of prednisone, and that helped with the swelling (no help with the pain or stiffness), but since finishing the prednisone, the swelling has come back.

Besides colitis, I do not have any other medical concerns or history like these issues. My father has mild psoriasis and an aunt has RA. Could this be related to my colitis or something like psoriatic arthritis or RA starting?


Category: Rheumatologist

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Category: Internal Medicine Specialist
Dr. Bimlesh Dhar Pandey is online now

Expert:  Dr. Bimlesh Dhar Pandey replied 4 Days.

?Thank you for your query at DoctorSpring.com.

Dear madam,

The condition affecting your finger is called as Dactylitis. It can be seen in Psoriatic Arthritis, Spondyloarthritis or Inflammatory Bowel Disease associated Arthritis (IBD associated Arthritis).

In your case, any of these can be a possibility. However, from the picture, your skin lesion is unlikely to be Psoriasis.

I would like some additional information.

- Do you get back ache, especially in the lower back, which is maximum during early mornings? Or do any of your siblings/ other family members have back ache?

My recommendation is that you talk to your Gastroenterologist for a referral to a Rheumatologist. You need to get some tests done like a complete blood count,  and markers of inflammation like erythrocyte sedimentation rate(ESR) and C-reactive protein (CRP) etc.

Prednisone is an excellent drug for your condition. You can also be put on Methotrexate/ Sulfasalazine if required along with the Prednisone to treat this condition and it may take some time, about 2 years for the Dactylitis to heal completely. However, you will get symptomatic relief within a week or earlier after starting treatment.

Let me know if you have any queries.

Kind regards?.



Patient replied :

Thank you for the response and information.
I have been noticing some lower back pain especially when I first wake up and also some later on in the day. My father and paternal grandmother also have back pain.
I will talk to my gastroenterologist and primary care.
Thank you again!


Expert:  Dr. Bimlesh Dhar Pandey replied 3 Days.

Thanks for writing to us again.



IBD can be associated with axial spondyloarthritis which is back ache maximum at rest and improves with activity. That is the probable cause of your pain. Kindly get in touch with your gastroentrologist for future management. Also do write to us if you have additional queries.



Take care,



Regards





Dr. Bimlesh Dhar Pandey
Category: Internal Medicine Specialist
Experience: 
Senior Residency: Rhematology, All India Institute of Medical Schiences, New Delhi, 2009
Post Graduate, Junior Residency: MD (Internal Medicine), Rajendra Institute of Medical Sciences, Jharkhand, 2006
Residency: Physiology, Institute of Medical Science, Banaras Hindu University, Varanasi, 2003
Internship: Government Medical College, Trichur, 2001
Medical School: MBBS, Calicut University, 2001
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