Previously Damaged Joints

[ruid]

Anyone know why joints with previous cartlilage damage don't seem to show the signs of PA as the healthy joints? I don't know the medical terminology (yet) but I have damaged left thumb joint the second from the tip that was damaged from years (1979-present) of video games (now hockey). My middle finger, second joint from tip, I cut down through the cartilage when I was a machinist 12 years ago. I was supposed to have a followup to have the damage assessed to see if surgery was necessary, I never did. I also have a left pinky knuckle that I broke in a fight up in Iceland while in the Air Force 14 years ago. I never saw a doctor for that either, now it is bigger than the knuckle of my index finger. The little pinky knuckle hurts before rain or during cold days and hasn't bothered me much lately while going through all sorts of pain with the PA. I am left handed and my right hand is the worst with pain of the two.
Hope to hear if anyone has experienced this.
Reed

[docmks]

Anyone know why joints with previous cartlilage damage don't seem to show the signs of PA as the healthy joints? I don't know the medical terminology (yet) but I have damaged left thumb joint the second from the tip that was damaged from years (1979-present) of video games (now hockey). Hope to hear if anyone has experienced this.
Reed

Hi Reed, I'm a Professor - a physical anthropologist - who specializes in the study of the skeleton, and how diseases affect the skeleton, so I'll take a shot at your question. Pathologists like to say "dogs can have fleas....and ticks." And those of us with PA can also have osteoarthritis which is also known as DJD or degenerative joint disease. It sounds like what you have from your injuries is a post-traumatic form of osteoarthritis and this is not uncommon. Osteoarthritis or DJD is often made worse or precipitated by damage to the joint cartilage, or some other component of the joint. Many joints develop osteoarthritis by normal wear and tear. Over time, cartilage will wear down in some cases, and the bone itself, underneath the cartilage also can have areas of damage as well. As the cartilage further wears down, you can actually have bone wearing against bone. The surfaces of the bone actually get a polished or shiny appearance when this happens, and ridges can develop on the surface of the bony joint surfaces. If you break a bone near a joint surface, this can cause the bones that make up that joint to align differently, and the misalignment can contribute to the development of osteoarthritis.

Now with PA, or psoriatic arthritis, as well as with rheumatoid arthritis, the joint problems are not due to "wear and tear." They are due to an inflammatory response that starts first within the components of the joint. Just why we have that inflammatory response take off is ultimately because we have an autoimmune disease (that's sort of circular reasoning, and I apologize for that). But the nature of this autoimmune disease (PA and P) is that we have inflammation that can start up in our joints, our skin and in the attachment areas where tendons attach to bone (often near joints). Abnormal levels of a cytokine, produced by this inflammatory response, are present in the skin and joint fluid of people with P and PA. That cytokine is a chemical produced by the body is called tumor necrosis factor alpha. The inflammation sets off a series of cellular events that affect the turnover rates of bone and skin cells. So in P, your skin cells are replacing themselves at an abnormally fast rate. In bone, what is seen first in your joints as inflammation may also promote the destruction of bone over time in PA (due to a higher than normal rate of osteoclastic activity--osteoclasts are cells that normally breakdown old bone, as part of the body's cell repair process).

I've probably told you way more than you want to know. Basically in PA and P the body's normal process of self repair are affected due to the abnormal inflammatory response. There are genetic factors involved, but they are not completely understood yet.

Let me know if this is not clear and I'll try to explain it better. The rest of you old timers let me know if I've left out anything.

mk

[ruid]

Thanks for that response. I'm not sure if my question was worded correctly (mental fatigue, it was late) but I appreciate that explanation. The damaged joints on my left hand don't exhibit the PA like the other joints on either hand. The healthy joints that are affected hurt just laying in bed, sharp stabs of pain or dull aches. The damaged joints are fine and don't show signs of swelling or pain other than occasional, they are enlarged because of scarred tissue and have been that way since they healed after injury. I'm sure in time they will also develop symptoms of PA or another form because of the damage. My right hand exhibits more pain, stiffness and swelling and has no disfiguring damage like my left hand. Do you think the scar tissue could be inhibiting the PA because it's physical and chemical makeup is not conducive to PA's normal progression?

All my joints hurt at some point, I go to bed every night wondering what is going to be painful the next day.

Reed

[docmks]

Do you think the scar tissue could be inhibiting the PA because it's physical and chemical makeup is not conducive to PA's normal progression?

All my joints hurt at some point, I go to bed every night wondering what is going to be painful the next day.

This is a really interesting question, Reed. I wish I knew the answer, but I'll think on it. In the meantime, maybe somebody else will know.

I think a lot of us wonder what's going to be painful the next day. PA is the most perplexing illness this way. Every day is a new experience!

mk

[JesseLou]

Reed - I have 2 painful joints in my dominant hand, the second from the top of the thumb, and the third from the top of the index finger. But the PA has not gotten into those JOINTS - it has given me enthesitis in the tendons used by those joints. There is another person on the board who has gotten that diagnosis - the only reason I know it is true for me, is because if I ice those tendons, I get relief from the pain.

I only have this in one hand.

The problem with enthesitis (inflammation where the tendons and ligaments enter bone) is that it refers pain to other places.