Dear Doctor Dysphoric:

Dear Doctor Dysphoric:

For the past few weeks, when I wake up in the morning, my fingers and toes are sore. Or, the joints in my fingers and toes are sore. What’s up with that? Is it that I am a nursing mom and my children are literally sucking the life out of me? Am I scaling mountains in my sleep? Or is my grandmother’s arthritis finally making it’s presence known? Isn’t there a pill or something I can take for this?

--Sore on East Seventh St.

Dear Sore on E. Seventh--

Sore fingers and toes are my bread and butter. They are very common, especially in the elderly. Joint pain is called "arthralgia" in Medspeak. If there is also swelling/redness present, we call it "arthritis."

The most common cause of arthritis is just plain old erosion of the joints that comes with old age ("osteoarthritis"). This is probably what your grandmother had. The picture on the upper left is of advanced osteoarthritis in the hands. However, the "Differential Diagnosis" (aka the list of possible etiologies) of arthralgia/arthritis is incredibly wide. Arthritis can be caused by all kinds of infections (e.g. bacteria, viruses), auto-immune processes (e.g rheumatoid arthritis or lupus), crystal-induced inflammation (e.g gout), cancers, and other random, poorly understood diseases (e.g sarcoidosis).

Knowledge of your age, your co-morbidities (other medical probs, in Medspeak), and related symptoms will help me narrow down the list of potential diagnoses. Something tells me that you are an otherwise healthy 37 year old woman with electric blue eyes. Perhaps you look a bit like Meg Ryan from the "You've Got Mail" era? Your lack of other chronic diseases and symptoms (fever, rash, hair loss, chest pain, shortness of breath, weight loss) makes a systemic illness like lupus or cancer incredibily unlikely. Gout is also quite unlikely, given that it generally effects just one joint at a time.

You are, however, in the correct demographic group for rheumatoid arthritis (RA). RA is a fairly common disease. It usually presents in women in middle age (no offense). It starts as morning stiffness in the small joints of the hands. It spares the most distant joints (near your fingertips), but attacks the knuckles and the wrists. The stiffness generally goes away after a couple of hours. The joints swell and get red. Most people will have low-grade fevers, and many have profound fatigue (due to low red blood cell count, aka anemia).

While RA is a possibility, perhaps the most likely cause of your pain is early osteoarthritis (OA). You are on the young side for OA symptoms--it usually comes on after age 50-- but your family history and your frequent use of your hands for activities such as rowing and pic-snapping puts you at higher risk.

In short, my suspician that your symptoms are related to a serious syndrome (like RA or lupus) is low. For now, take 2 extra strength tylenol three times a day as necessary for the pain. You should avoid other pills while you are breast-feeding. If you develop other symptoms, such as fever or profound fatigue, you should see a MD for an exam and lab tests.

Enjoy those beautiful babies and your prodigious talent--

--Doctor D

(ps-- the pic on the upper right is advanced gout. I did not want to post the advanced RA pic, for fear of alarming both you and the casual blog reader.)