What should I expect the GP to do? Swollen hands every morning

[Gptoday]

I have a GP appointment coming up. Wondering what I should be expecting them to actually do?

I have been having swollen hands every morning for going on a year now - especially in my right hand. They are painful and throbbing but no numbness or tingling. I cannot really use my right hand in the mornings due to the swelling and associated pain. The swelling goes down eventually though. I have had the GP previously try antihistamines Incase my right hand has been bitten as it was summer, I then had an X-ray last year of my hand which came back normal however I am going back as the problem hasn't resolved and it's been a long time now and my left hand is also swelling slightly but the right is still definitely the worst.

What should I expect (if anything)? I am not the best at advocating for myself but this is going on and on and I'd like to get to the bottom of it.

Other symptoms which may or may not be related:
Itching in my hands when they are swollen
Weight loss
Very very tired (but could be low ferritin as every blood test I have that)

Have you been tested for diabetes/pre diabetes? What is your blood pressure like?

It sounds like carpal tunnel.. I had this and really bad itching on my hands when I was pregnant and it was all down to excess fluid in the carpal tunnel

Have you tried a wrist splint overnight? That helped me but didn't fully get rid of the symptoms

Is it possible you are sleeping on them funny? I often put my hands in odd positions and sometimes wake up with them numb or tingly, not checked or noticed if they were swollen though.

Might be worth taking pictures when they are swollen to compare to normal?

I get this. I've been diagnosed with joint hyper mobility and given some compression gloves to wear at night which helps if they're flaring up.

I'm surprised that the Dr isn't investigating this properly as that doesn't sound great. There are lots of relatively innocent things it can be. Arthritis, Scleroderma, but also fluid retention because of kidney issues and even heart issues that surely they should follow up?! Now it's in both hands I hope they look further. The tiredness symptom could be linked or not. I would really push and if you don't get anywhere with one Dr ask for a second opinion.

Thanks all for taking the time to reply.

Have been tested and no diabetes. Also had regular bloods etc - all normal bar ferritin.

I don't think I'm sleeping on them funny as occasionally it happens in the day too. My hands also go kind of shiny when they are swollen.

I was about to suggest low iron/ferritin when I see you've already found that out!

Is your low ferritin being treated?

@Cerialkiller thank you sorry, cross posted.
This is a different GP actually, the previous one who did the X-ray etc kind of let it slide and didn't follow it up so hopefully this one will.
I was wondering about arthritis as I have also had uveitis in both eyes and various bouts of inflammation in my bloods but everything else (ANA, RF) is normal! It's a real mystery!

@Mumoftwo1312 my ferritin has been treated in the past when it's been 7 but not really gone past 15 where they then just suggest vitamin supplements and changes in diet. I don't have periods due to contraception too so that is another mystery!

I'd ask for a referral to rheumatology. RF isn't always raised and there are other inflammatory arthritis diagnoses that a rheumatologist might consider.

I get swelling (and other, more dreadful symptoms) when my ferritin goes too low. I'd ask for iron supplements again. Your gp might argue your ferritin isn't low enough to "need" them, but you can argue it isn't high enough that they're excessive. And it really might help. Honestly I was reading your op thinking "I'm going to suggest low iron reserves" and got to the bottom and there it was

You could go on the iron alongside other investigations etc, I mean

Could you take a full days dose of an anti-inflammatory for a few days like ibuprofen and see if there is improvement? Might help narrow it down.

A ferritin level of 15 is dreadful! It should be around 90 at least for crucial enzymes to work properly. That's low enough to make you feel deathly tired. However I don't think it can be a cause of swollen hands, so that really does need to be further looked into.

I presume you've had thyroid blood tests, do you have any recent results for that?

@Cerialkiller

@CrunchyCarrot

I was prescribed naproxen originally last summer, it helped.

And yes, I feel pretty awful but nothing like when it was 7! Here's the latest results from December.

i have rheumatoid arthritis and woke up one morning with swollen hands deathly tired. Get referred to rheumatologist- they can do an antibody test (mine was off the scale) but it can be sera negative and not show up. Get referred.

Also I just noticed my sodium was nearly out of range. Might be related?

Your TSH is OK but your FT4 (that's the storage thyroid hormone from which active thyroid hormone is made) is on the low side. I'd want to see FT3 (active hormone) level in case that's low too. Hard to get it from a GP though, you can get it from a finger prick blood test you can buy online, if you are curious, but I don't think you need to be overly worried about that right now.

Not sure whether sodium a bit high in range is relevant (other than salt holding onto water molecules) because sodium/potassium are constantly being adjusted by your body so an hour later that result could be different.

As @Whoopsmahoot says, maybe it's the start of rheumatoid arthritis. That can be tested for (antibodies). I do hope you get to the bottom of it.

Oh the other important thing is your weight loss - that also could be associated with RA developing.

Could you try eliminating nightshades (tomatoes, potatoes, peppers etc) from your diet and reintroduce them to see if that has an effect? Do it for 2 weeks. Then gradually reintroduce tomatoes etc. this could be the cause of the inflammation.

I'd be asking about inflammatory arthritis and if you have had autoantibodies checked.

Even if negative it could still be inflammatory arthritis so needs a rheumatology referral.

My Dad was experiencing very similar symptoms in his hands and he was eventually diagnosed with Polymyalgia Rheumatica which is a form of arthritis I believe.

Thank you all again for responding and giving me some confidence today.

GP is doing all inflammatory bloods etc for arthritis and additionally checking CA125 and celiac too due to weight loss.

A referral to rheumatology to check for rheumatoid arthritis.

That's good news OP! Do let us know how you get on. 😊