Can RA worsen wrist pain at 40 despite steroids?

Question

Hello doctor,

I have had wrist pain for a few years—local steroid injections worked until the last six months. I have had two so far, but the pain is not letting up. It is spreading to the hand and fingers. I also have discoloration on my hand. There is swelling at the base of the hand above the wrist. It feels hard like a bone. It is painful. I cannot squeeze, twist, or lift with my hand anymore. Those actions cause pain, and there seems to be some weakness. I cannot afford to see a rheumatologist where I am. That is why I am here. I am currently being treated for Axial Spondyloarthritis and RA. Also, I am taking Methotrexate 7.5 mg weekly, and I was on Depo Medrol 80 mg locally.

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

Thanks for sharing all these details. Your symptoms wrist pain spreading to the hand and fingers, discoloration, swelling that is hard like bone, weakness, and inability to do movements without pain—along with your background of axial spondyloarthritis (AxSpA) and rheumatoid arthritis (RA), plus ongoing Methotrexate and prior steroid injections, suggest a concerning progression of your condition.

Here is what might be going on:

Active inflammatory arthritis flare or progression: RA and AxSpA can cause ongoing joint inflammation, swelling, and damage, especially if not fully controlled. Hard swelling could be bony proliferation or possibly a large synovial cyst, or even joint erosion with deformity.
Tenosynovitis or tendon involvement: Inflammatory arthritis can inflame the tendons around the wrist, causing pain, swelling, and limited movement.
Nerve involvement: The spread of pain to the fingers, weakness, and discoloration could indicate nerve compression (such as carpal tunnel syndrome) or vascular involvement.
Infection or secondary complications: Low-grade fever, discoloration, and swelling raise the possibility of infection (septic arthritis or cellulitis), especially since you have been on immunosuppressants.
Possible avascular necrosis or bone pathology: Hard swelling and discoloration could be related to bone death or abnormal bone formation.

What you should do urgently:

Seek urgent evaluation, preferably imaging like an X-ray of the wrist and hand to look for bone erosion, fractures, or deformities. Ultrasound or MRI (magnetic resonance imaging), if possible, for soft tissue and tendon involvement.
Laboratory tests: Complete blood count (CBC), inflammatory markers such as CRP (c-reactive protein), ESR (erythrocyte sedimentation rate), and blood cultures if fever persists.
Medical attention for infection: Because of your immunosuppression, infection risk is higher and can worsen rapidly.
Interim advice for you: Avoid using the affected hand for heavy activities (lifting, twisting).
Pain relief: Use NSAIDs (non-steroidal anti-inflammatory drugs) if you can tolerate them and there are no contraindications. Cold compresses may reduce swelling and pain.
Elevate the hand to reduce swelling. Monitor fever and any spreading redness or worsening discoloration—these are emergency signs.

Important: Your symptoms with fever and worsening pain, and discoloration are concerning and need medical assessment urgently. If you cannot see a rheumatologist, try visiting a general physician or emergency department to rule out infection or other urgent causes. Continuing Methotrexate is generally important, but if infection is suspected, it may need to be stopped temporarily — this decision must be made by a healthcare provider.

Summary: You are experiencing a potentially serious complication of RA/AxSpA or an infection. You must get urgent medical evaluation for imaging, labs, and possible treatment. If you develop a high fever, spreading redness, severe swelling, or inability to move your fingers, seek emergency care immediately.

I hope you find this helpful.

Thank you.