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In late March 2012, I awoke with pain in my left hand. I had difficulty moving my metacarpophalangeal (MCP) joints. They did not move smoothly, but clunked. As I repeatedly attempted to open and close my hand, I realized that I had morning stiffness. As the pain and stiffness gradually improved over the next hour, I remained in disbelief and hoped that it would not return. I would not experience another morning without joint stiffness until I took prednisone.
I am a rheumatologist who has developed rheumatoid arthritis (RA). I completed my rheumatology fellowship at Brigham and Women’s Hospital, Boston, in 2001. During my fellowship, I studied the post-translational regulation of cytokine production. I also wrote a review on intracellular signaling in RA, never imagining that I would one day have the disease myself.
The Onset
In 2010, I first experienced foot and ankle pain during a weeklong gastrointestinal illness. The stiffness that accompanied this joint pain made me suspicious of an inflammatory etiology. However, I had no joint swelling. When the joint pain recurred several times during the next year, despite resolution of the intestinal symptoms, I wondered if I might be imagining it. I mentioned the joint symptoms to my primary care physician, but I deferred any additional testing, because I did not have synovitis, and months passed without any symptoms. I was able to hike up a 10,000-foot mountain and swim 2,500 meters without difficulty.
I can never be just a patient, because my own knowledge base & experience influence every visit.
Soon after my first episode of hand stiffness, my metatarsophalangeal (MTP) joints and ankles became persistently painful and swollen. The morning stiffness was most severe in my hands and feet. My wrists, hips and knees also began to hurt. I experienced overwhelming fatigue. Any doubts about the reality of my predicament faded one morning as I got ready for work. I glanced at my feet, and I realized my right 4th and 5th toes were deformed. My previously straight toes were now floppy and crooked. I also developed a change in the shape of my right hand. My MCP joints were no longer perfectly aligned. The 2nd and 3rd were more prominent, and the 4th and 5th had a more sunken appearance. It was alarming how quickly these changes occurred.
Dr. Piecyk, wearing a shawl she knitted.
