Sunday 25 February 2018

Dear Dr Nina: My hands are swollen. Could it be arthritis?

Photo posed
Photo posed

Nina Byrnes

My knuckles and hands are becoming increasingly swollen the older I get and they are becoming very unsightly. I'm very conscious of them and have taken to wearing gloves as much as possible. The knuckles on my left hand are particularly swollen and I can't take my wedding ring off any more - I haven't for four or five years now. They seem to get more swollen in the winter and improve a bit in the summer. I'm in my late forties, but could this be arthritis? My joints aren't painful and I don't have any other health problems, but arthritis does run in the family. I'm worried that they could become painful in time and wondering should I look for some medication to avoid this.

Dr Nina replies: Arthritis is a medical term used to describe joint swelling and inflammation. It can affect any joint, but the hands are commonly affected. You describe joint swelling that although not painful, is worse in cold weather and better in warm weather. This is quite typical of arthritis.

It has been estimated that one in six Irish people suffer from arthritis. Women are more likely to be affected than men and it is a factor in up to 30pc of GP consults. However, this is not a single disorder there are over 100 different types. The disease shouldn't be underestimated, it is the single biggest cause of disability in Ireland and is estimated to cost over 1.5 billion euro per annum to the state in lost working hours.

The majority of cases of arthritis present in people over the age of 55, but it can occur at any age. The most common form of arthritis in those over 50 is Osteoarthritis. This develops when cartilage - a tissue that covers the ends of bone in a joint - becomes worn down. Cartilage normally protects the bones and helps absorb pressure and movement in the joint. When this becomes thinner the bony surfaces become exposed rubbing off each other and this leads to pain and inflammation. Over time the joint then deteriorates further. Serious joint damage can occur.

Osteoarthritis is most common in the hips, knees, and spine although it can occur elsewhere. People commonly complain of pain and stiffness that get worse with exercise or use of the joint and there is often a sense of clicking or grinding. Movement often becomes quite limited. The symptoms are often worst when mobilising after prolonged rest or sleep.

Most people present to their doctor complaining of pain and seeking answers. Even though you have no pain a visit to the doctor is important to make the correct diagnosis.

Unlike other forms of arthritis blood tests are not usually helpful. X-rays are not always necessary to diagnose but can help ascertain the extent of joint damage. Answers can be difficult to get as the exact cause of osteoarthritis is not known.

Obesity makes arthritis worse. The skeleton is put under serious strain by excess body weight. Maintaining activity is vital as exercise helps preserve the movement and function of the joint. Water based exercise can be especially helpful.

Osteoarthritis can develop in joints that were injured earlier in life so it is important to take any joint damage seriously and ensure proper rehabilitation and follow up. Returning to exercise too soon can have consequences down the road. People often associate a change in weather with increased pain particularly if the weather is damp.

This has not been confirmed in clinical trials and osteoarthritis occurs in all climates. There is no cure for osteoarthritis so the goal of treatment are to reduce pain, improve mobility and improve muscle strength. As you have no pain keeping the joints flexible is important Mobility is improved through exercise and joint strengthening. Following a recommended exercise plan can provide huge benefits. Glucosamine, or fish oil supplements can help in some cases.

Q. I’ve always been careful to wear sunscreen but now my GP says that a small growth on my cheek — which I’d barely even noticed — needs to be checked out. It’s painless but should I be worried?

Dr Nina replies: Moles are small spots on the skin made up of pigmented cells. The amount you have will depend on your genetics and your skins exposure to ultraviolet light. New moles may appear up to age 30. Any that appear after that should be watched closely.

Moles do change over time. They may also evolve during adolescence and pregnancy where they increase in number and change in colour. As we get older, some moles may change or disappear altogether. Those who have more than 100 moles over their bodies may be at higher risk of abnormal moles and it is important to keep an eye on them. The best way to reduce your risk of abnormal change in your moles is to limit the skin exposure to UV radiation. Avoid the sun or wear at least factor 50 when you are exposed. If you have many moles it is important to make sure you have adequate blood levels of vitamin D, melanoma may be more significant in those who don’t.

Most moles are completely harmless and will never cause you any problems. There are some features you need to watch out for. This is referred to the ABCDE grading. A is for asymmetry. Benign moles are largely symmetrical. B is for border. Check for changes in the outline or bleeding of pigment over the border of the moles. C is for colour. Some benign moles may have two shades of brown, but melanoma may have several areas of pigment. Colour change in a mole should be noted. D is for diameter. A growing mole is one to watch. Lastly E is for elevation. A mole that becomes more raised especially in conjunction with any of the other features should be reviewed.

It is most likely that the mole you have is benign or easily treated, but getting checked is important.

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