some questions | Arthritis Information

 

Hi all.  I haven't been here in a while.  Life's been getting in my way.  Anyway, I have a few questions for you guys.  I have been diagnosed with OA.  My first diagnosis several years ago was Fibromyalgia, followed by RA.  The OA popped up within the last year and half.  I haven't been on any meds... financial reasons.  Things have been going ok, until the past 6 months or so, when my neck started giving me problems.  With x-rays and mri's, they found "arthritis changes and disc degeneration" from the cervical spine all the down into the lumbar.  My knees are about shot.  My feet hurt all the time.  I am having more and more difficulty raising my arms past shoulder height because my shoulders are so bad.  I finally broke down and had to go see my RD.  She's done some blood work, which we're waiting to come back, to see what exactly is going on before we start treatment.  I have a question though.  She pointed out that my fingers were clubbing, as were my toes.  She was convinced I had a lung disease, which the clubbing usually indicates.  x-rays were clear.  Does anyone else have any AI condition or anything else that may cause clubbing that perhaps my RD hasn't thought about?  Something I can have her maybe look into?  Also, when I was first diagnosed with RA, I also had a "reversable cardiomyapathy."  When my RA went into remission, the cardiomyapathy cleared up.  Is it possible that it could have resurfaced, causing a circulation problem, and leading to the clubbing?  Any help would be greatly appreciated.

Cris

Although many diseases are associated with clubbing (particularly lung diseases), the reports are fairly anecdotal. Prospective studies of patients presenting with clubbing have not yet been performed, and hence there is no conclusive evidence of these associations.

[edit] Isolated clubbing

Clubbing is associated with:

• Lung disease:
  • Lung cancer, mainly large-cell (35% of all cases), not seen frequently in small cell lung cancer^[3]
  • Interstitial lung disease
  • Tuberculosis
  • Bronchiectasis
  • Suppurative lung disease: lung abscess, empyema
  • Cystic fibrosis
  • Pulmonary hypertension
  • Mesothelioma
  • It is worth noting that clubbing is not associated with chronic obstructive pulmonary disease (COPD). Indeed, the presence of clubbing in a patient with COPD should prompt a search for an underlying (lung) cancer.
• Heart disease:
  • Any disease featuring chronic hypoxia
  • Congenital cyanotic heart disease (most common cardiac cause)
  • Subacute bacterial endocarditis
  • Atrial myxoma (benign tumor)
• Gastrointestinal and hepatobiliary:
  • Malabsorption
  • Crohn's disease and ulcerative colitis
  • Cirrhosis, especially in primary biliary cirrhosis^[4]
  • Other liver diseases (in the "hepatopulmonary syndrome", a complication of cirrhosis)^[5]

• Others:
  • Hyperthyroidism (thyroid acropachy)^[6]
  • Familial and racial clubbing and "pseudoclubbing" (people of African descent often have what appears to be clubbing)
  • Vascular anomalies of the affected arm such as an axillary artery aneurysm

(in unilateral clubbing)

Thanks.  This does help some.  Gives me something to look into.  Wierd thing is, she says she's never seen it in the toes, and my toes are doing the same thing.  My fingers aren't anywhere near what those in the picture are, but you can tell that the ends of my fingers are fatter than the rest of the finger. Thanks for the information.  Like I said, the x-rays were clear, so I need to get her to look into what else could be causing it.

Cris,

Altho it can be seriously serious it may be somethng not at all as serious as it could be and am hoping that it's the least of the serious.

LEV

Clubbing of the fingers or toes

Definition:

Clubbing is a thickening of the flesh under toe and finger nails. The nail curves downward, instead of lying flat.

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