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Arthritis (Expert Forum)
Hands - Heat , Pressure and Touch Sensitive
Answered by
Kevin Pho, MD - Internal Medicine
Kevin Pho, MD
Boston - MA
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Hands - Heat , Pressure and Touch Sensitive
by deedee4, Jun 13, 2004 12:00AM
About 3 mos ago notice my hands hurt more when carrying briefcase, groceries and chopping food. Hands would be left with a red line whenever pressure was applied. Skin on hands actually doesn't feel as resilient as it used to be. Also, the skin is very touch sensitive, it hurts to crumble up a piece of paper and push on the end of a paperclip. Both leave dents in my skin.
If my hands are down below my heart they take on a red reticulated look. If I hold them above my head they go back to the normal white color. Sometimes my fingers will tingle and throb when I've been using them alot. Also, sometimes I can feel heat coming off of my hands. If I'm in a very hot room, above 85, my hands will go red and throb.
I am a 46 white female and work at a desk job. I haven't used any unusual chemicals, metals or machinery. For 6-8 mos prior to this problem I had been tired and having night sweats. I also have a problem that I have dry skin all over by body. Clothes feel like sandpaper against my body. Also, have red bumps on tongue and it is sore.
I had blood test for lupus and ms which were normal. My other blood work is also normal, sed rate, c reactive protein and ANA anti-bodies. All other blood normal. MRI of brain also normal. Will be having MRI of spine tomorrow.
Currently taking 200 mg of Nerontin and .375 mg of Xanax daily. Also taking 10mg of aciphex. Don't smoke and don't use recreational drugs. Had been in habit of having 15-20 drinks per week. Quit drinking about 2 months ago. Height 5'3", weight 118 lbs, after having lost 10 lbs due to feeling ill.
Family practice, endocrinologist, infectious disease and dermo drs. have no clue. Some ideas they are throwing out are scloerdema, raynauds and erythromelagia.
What tests would need to be done to rule out any of these conditions. What kind of dr. should I see that could do these tests. Do you have any other ideas of what other kinds diseases or tests should be considered?
If my hands are down below my heart they take on a red reticulated look. If I hold them above my head they go back to the normal white color. Sometimes my fingers will tingle and throb when I've been using them alot. Also, sometimes I can feel heat coming off of my hands. If I'm in a very hot room, above 85, my hands will go red and throb.
I am a 46 white female and work at a desk job. I haven't used any unusual chemicals, metals or machinery. For 6-8 mos prior to this problem I had been tired and having night sweats. I also have a problem that I have dry skin all over by body. Clothes feel like sandpaper against my body. Also, have red bumps on tongue and it is sore.
I had blood test for lupus and ms which were normal. My other blood work is also normal, sed rate, c reactive protein and ANA anti-bodies. All other blood normal. MRI of brain also normal. Will be having MRI of spine tomorrow.
Currently taking 200 mg of Nerontin and .375 mg of Xanax daily. Also taking 10mg of aciphex. Don't smoke and don't use recreational drugs. Had been in habit of having 15-20 drinks per week. Quit drinking about 2 months ago. Height 5'3", weight 118 lbs, after having lost 10 lbs due to feeling ill.
Family practice, endocrinologist, infectious disease and dermo drs. have no clue. Some ideas they are throwing out are scloerdema, raynauds and erythromelagia.
What tests would need to be done to rule out any of these conditions. What kind of dr. should I see that could do these tests. Do you have any other ideas of what other kinds diseases or tests should be considered?
Doctor's Answer
by Kevin Pho, MD, Jun 16, 2004 12:00AM
, Jun 16, 2004 12:00AM
For scleroderma, there are several considerations. The first would be autoimmune antibodies - including anti-centromere, anti-topoisomerase-I (Scl-70), anti-RNA polymerase, or U3-RNP antibodies. A rheumatologist can order these tests.
The diagnosis of the Raynauds is based on the history alone since there is no simple office test to confirm the presence of cold or emotion induced vasospasm and provocative testing is not recommended. This most often affects the hand; attacks also frequently occur in the toes, but patients are less likely to complain of lower extremity symptoms. A typical episode is characterized by the sudden onset of cold fingers (or toes) in association with sharply demarcated color changes of skin pallor (white attack) and/or cyanotic skin (blue attack).
Erythromelagia can be a sign of a disease known as polycythemia vera. A serum epogen level can be considered. This disease is normally managed by a hematologist (blood specialist).
I certainly would consider the tests mentioned above to rule out the disorders. A rheumatology consult can be considered to evaluate for scleroderma and Raynauds. A hematology consult can be considered to evaluate for erythromelagia.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
Medical Weblog:
kevinmd_b
Bibliography:
Korn. Overview of the manifestations and diagnosis of scleroderma. UptoDate, 2004.
The diagnosis of the Raynauds is based on the history alone since there is no simple office test to confirm the presence of cold or emotion induced vasospasm and provocative testing is not recommended. This most often affects the hand; attacks also frequently occur in the toes, but patients are less likely to complain of lower extremity symptoms. A typical episode is characterized by the sudden onset of cold fingers (or toes) in association with sharply demarcated color changes of skin pallor (white attack) and/or cyanotic skin (blue attack).
Erythromelagia can be a sign of a disease known as polycythemia vera. A serum epogen level can be considered. This disease is normally managed by a hematologist (blood specialist).
I certainly would consider the tests mentioned above to rule out the disorders. A rheumatology consult can be considered to evaluate for scleroderma and Raynauds. A hematology consult can be considered to evaluate for erythromelagia.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
Medical Weblog:
kevinmd_b
Bibliography:
Korn. Overview of the manifestations and diagnosis of scleroderma. UptoDate, 2004.
Good Luck!!