Doctor – I Have Symptoms of Pain and Swelling in My Hands and Feet – What Could It Be?
By Nathan Wei
While there are multiple causes of swelling and pain in the hands and feet, arthritis is probably the most common cause.
The term “arthritis” is derived from the Greek and means “joint inflammation”. It refers to more than 100 different diseases that can cause pain, swelling, and stiffness in the joints. Joints are where the ends of long bones connect and interact. The end of each bone inside a joint has a thin layer of cartilage and is held in place by ligaments, tendons, and muscles. A joint is lined with synovial tissue (synovium) that helps to nourish the joint. It is the synovium that often becomes inflamed in arthritis.
Arthritis may also affect other supporting structures around joints such as the muscles, tendons, ligaments, and bones. Some serious forms of arthritis can affect internal organs.
The common symptoms of arthritis are due to inflammation (swelling, heat, redness, pain):
Diagnosing arthritis can be difficult because some symptoms are often common to many different diseases. A rheumatologist will first do a complete physical exam, looking for clues. The eyes, ears, nose, throat, heart, lungs, and other parts of the body will be examined along with the joints. Lab tests and imaging procedures such as x-ray, ultrasound, or magnetic resonance imaging (MRI) may also be ordered.
The most common forms of arthritis are:
Osteoarthritis (OA) is also referred to as degenerative joint disease. This is the most common type of arthritis. When it affects the hands, it can cause painful swelling in the last row (Heberden’s nodes) and middle row (Bouchards nodes) of finger joints. In the feet it will affect the toe joints as well as the mid-foot. This disease affects cartilage, the tissue that cushions and protects the ends of bones in a joint. With osteoarthritis, the cartilage starts to wear away prematurely. The swelling of the fingers and toes may lead to bony deformity.
Rheumatoid arthritis (RA) is an autoimmune disease; the body’s immune system (defense mechanism against infection) attacks normal tissues. This autoimmune reaction causes inflammation of the synovium. RA symptoms include pain, stiffness, swelling, rapid loss of joint function, and crippling. When severe, rheumatoid arthritis can also affect internal organs. This is the type of arthritis that most commonly causes severe inflammation in the hands and feet.
Rheumatoid arthritis tends to be symmetric- one side of the bodt being affected just like the other.
Fibromyalgia is a chronic disease characterized by generalized aches and pains. The pain is accompanied by stiffness that is worst in the morning but tends to last all day long. Patients may have localized tender points occuring in the muscles and tendons, particularly in the neck, spine, shoulders, and hips. These tender points are called trigger points. Fatigue and sleep disturbances may also occur. There is subjective swelling along with pain in the hands and feet.
Gout and pseudogout are inflammatory forms of arthritis due to deposits of crystals in joints and other body tissues. Uric acid is the culprit in gout and calcium pyrophosphate is the villain in pseudogout. Both diseases cause painful attacks of arthritis affecting the hands and feet.
Infectious arthritis is a type of arthritis caused by either bacteria or viruses. A relatively common form of infectious arthritis is Lyme disease. Infectious forms of arthritis can cause swelling and pain in the hands and feet. A diagnosis is often difficult to establish. Antibiotics will often be used to treat bacterial infectious arthritis.
Reactive arthritis is an autoimmune arthritis that develops after a person has an infection in the urinary tract or intestine. This problem is often referred to as Reiter’s disease. People who have this disease often have eye inflammation (iritis), rashes, and mouth sores. Inflammatory arthritis involving the hands and feet leading to a toe or finger that looks like a sausage (dactylitis) is common.
Psoriatic arthritis. Some people who have psoriasis also have arthritis. This disease often affects the hands and feet. It is usually asymmetric. It also causes deformity of the fingernails and toenails (onycholysis) that is often misdiagnosed as a fungal problem. Sometimes the spine- neck and low back-can be affected. As with Reiter’s disease, dactylitis often occurs.
Systemic lupus erythematosus is another autoimmune disease. Lupus can affect many organ systems including the joints, skin, kidneys, lungs, blood vessels, heart, and brain. This is a cause of swelling and pain involving the hands and feet.
Juvenile rheumatoid arthritis is the most common type of arthritis affecting children. It leads to pain, stiffness, swelling, and loss of function in the joints. A patient can also have rashes and fevers with this disease. Hands, wrists, ankles, and feet are often affected.
Polymyalgia rheumatica. Symptoms include pain, aching, and morning stiffness in the shoulders, hips, thighs, and neck. It is sometimes the first sign of giant cell arteritis, an inflammatory disease of the arteries characterized by headaches, scalp tenderness, weakness, weight loss, and fever. The hands and feet may be affected although less often than other joints. The erythrocyte sedimentation rate (sed rate), a blood test that measures inflammation, is often greatly elevated.
Bursitis is inflammation of the bursae- the small, fluid-filled sacs that help cushion joints. The inflammation may accompany arthritis in the joint or injury or infection of the bursae. Bursitis produces pain and tenderness and may limit the movement of joints.
Tendinitis is inflammation of tendons (the fibrous cords of tissue that connect muscles to bones) caused by overuse, injury, or arthritis. Tendinitis produces pain and tenderness and may restrict movement of joints.
Not all conditions that cause symptoms of pain and swelling in the hands and feet are due to arthritis. Here are some non-arthritis causes…
Polycythemia vera (PV) is a disorder that is due to excessive production of red blood cells, white blood cells, and platelets. Some patients with PV will not have any symptoms at all, but many will experience easy bruising or bleeding with minimal trauma. Also, the blood may become thick, causing it to clot in tiny blood vessels. If clotting does occur in the small blood vessels of the fingers and toes, a patient may experience numbness or burning. Swelling and pain in the hands and feet may also occur.
Some medical conditions cause edema…swelling of the hands, ankles, feet, face, abdomen, or other areas of the body. Swelling is most often seen in the hands, in the feet, or around the eyes. The swelling often causes pain.
Edema is due to excessive fluid accumulation. It can be caused by abnormal kidney function, chronic kidney disease, congestive heart failure, varicose veins, phlebitis, protein or thiamine deficiency, sodium retention, or cancer.
Other reasons for edema are pregnancy, standing for prolonged periods of time, premenstrual syndrome, oral contraceptives, an injury (sprain), hypothyroidism (low thyroid), anemia, adrenal disease, deficiencies of potassium and B vitamins, or allergic reactions.
The cause of the edema needs to be determined. Diagnoses such as congestive heart disease, kidney disease, or liver disease should be ruled out.
Insect stings can lead to swelling and pain in the hands and feet. The same type of reaction may occur with medications, such as penicillin or sulfa. This is referred to as serum sickness.
Acromegaly is a disease where a tumor in the pituitary gland causes an overproduction of growth hormone. This leads to swelling and pain in the hands and feet.
Frostbite is another cause of swelling and pain in the hands and feet.
Blood clots in the veins are another cause of swelling and pain in the limbs. This rarely affects the upper extremities (arms). If it does, diseases associated with clotting abnormalities should be suspected.
Reflex sympathetic dystrophy (causalgia) is an unusual disorder that leads to swelling and pain in an affected limb. Generally it occurs in an arm or a leg, rarely both at the same time. The preceding event is usually some type of trauma.
Dr. Wei (pronounced “way”) is a board-certified rheumatologist and Clinical Director of the nationally respected Arthritis and Osteoporosis Center of Maryland. He is a Clinical Assistant Professor of Medicine at the University of Maryland School of Medicine and has served as a consultant to the Arthritis Branch of the National Institutes of Health. He is a Fellow of the American College of Rheumatology and the American College of Physicians. For more information on arthritis and related conditions, go to:Types of Arthritis