Kickas.org Forums Ankylosing Spondylitis General Discussion #1 AS Web Support Group Is thumb pain AS related?

Hi everyone,
I have a question about patterns of pain and whether I have some overuse type injury to my thumbs or whether it is a new site of pain in a flare-up.
I have pain in my left (non-dominamt) hand more than in my right dominamt hand. I can't recall any specific activity that I did which resulted in an overuse type tendonitis. It just seemed to get gradually worse. The pain is primarily between the wrist and the first large joint in the thumb. It had got to the point where doing everyday things like gripping cups, bowls, etc is difficult.
I haven't read about the thumbs being affected when AS flares. Any feedback or advice would be much appreciated.
Thanks,
Constance

Hello, Constance:

Yes, when my AS was active, I got sometimes severe inflammation right at the base of my thumbs and at the padding area where they are attached to my hands; dactylitis is very common in AS-family diseases.

HEALTH,
John

That area has given me a lot of grief. My wrist/thumb area would get hot to the touch when it was painful. I found out years ago that Aspercream helped, along with ice packs. You might ask your Dr for a script for Voltatian Gel. My right wrist has been less painful lately because something in the joint has fused.

I've just recently started getting pain in that area, mostly right thumb but a wee bit in the left as well. The right thumb I thought was triggered when I caught the thumb and pulled the tendon a bit, but then the way the pattern of pain went, I realised it had probably been rather stiff anyway before I knocked it, and that was just the last straw. I've been putting on voltaren gel, and icing it, and it hasn't got too bad so far, but still doesn't feel quite right.

Sounds like DQ (De Quervain's) tenosynovitis:

http://www.mayoclinic.com/health/de-quervains-tenosynovitis/DS00692

One of the main symptoms of the spondyloarthropathies is enthesitis:

http://en.wikipedia.org/wiki/Enthesitis

The entheses are where the tendons and ligaments attach to the bones.

I had terrible enthesitis, had so many tendinitises / tenosynovitises, pulled and torn tendons and ligaments even, where they attached to the bones.

DQ tendonitis / tenosynovitis was my first. In my left wrist, first. Then when I overused my right hand to compensate, got it in the right as well.

Had to go for a cortisone shot in the left wrist. And went to PT (a hand therapist) for a few months. Both were extremely helpful. But I had a very bad case of it; so much scar tissue that barely moving my thumb would set up more inflammation and more scar tissue.

Yours doesn't sound nearly that bad.

For us, just normal daily use can be "overuse" as any use at all can be "overuse".

But there are things that can help. if it isn't too bad, you may be able to manage it on your own.

Contrast baths help a lot. Gel ink pens instead of ball point help a lot; uniball are my favorite for smoothness and ease of use. Not turning pages of a book, magazine, etc; that's very repetitive for that tendon. Limited scissors use, limited keyboard thumb use (i switch to a mouse over a touch pad when mine flares).

When it comes to enthesitis, pretty much any enthesis can become involved.

I started taking LDN (low dose naltrexone) 3 years ago. Have not torn a tendon or ligament since. And my tendinitises are infinitely better as well; they don't flare nearly so badly, and they don't last nearly so long. Its been the one thing that LDN has impacted the most.

Thanks to everyone who has posted for your info and helpful ideas. I shall look into the options you have all suggested.
Cheers
Constance

Hi yes I get pain and swelling around the joint at the base of my thumb and the segment of my thumb between the joints is the first place to swell up before I'm due for my weekly methotrexate shot.

I had alot of problems throughout my hands and fingers and wrists - joints and tendons - and the best thing for it has been the MTX. Humira also helps but not as much and none of the nsaids I tried helped either. And the low starch diet helps the rest of me but doesn't seem to help my hands...