• A woman in her mid-50s had pain and tenderness in her fingers and swelling in her wrists

Hand and Wrist Pain That Moves Between Hands: A Rheumatoid Arthritis Case Study

October 1, 2026

CONTENTS

shoulder pain specialist singapore

Written by Dr Bernard Lee Mun Kam,
Founder & Consultant Pain Specialist, Singapore Paincare Center
MBBS (NUS) · M Med (Anaesthesiology) (NUS) · FFPMANZCA (ANZCA)

Last updated: 1 October 2026

This case at a glance

Patient Woman in her mid-50s, with diabetes
Main Symptoms Morning stiffness, finger tenderness and wrist swelling; pain moved between hands
Duration About 2 years
Tried Before Paracetamol and an NSAID (mefenamic acid): no relief
Key Test Result Raised ESR and CRP (blood markers of inflammation)
Diagnosis Rheumatoid arthritis (autoimmune inflammatory arthritis)
Treatment Low-dose corticosteroid plus a DMARD
Outcome Pain and swelling settled within 2 weeks; ongoing treatment needed

Presenting Complaint:

A woman in her mid-50s had sore fingers and swollen wrists for about two years. Each morning, her wrists and fingers felt stiff, tight and painful. The pain did not stay in one hand. Some days it was in one hand. Other days it moved to the other.

The pain made daily tasks hard. She struggled to carry light objects or wash a few dishes. She woke at least three times a night from pain. She also has diabetes.

She had tried paracetamol. She had also tried mefenamic acid, a common anti-inflammatory painkiller (NSAID). Neither eased her pain. She had been told the cause might be bathing late at night, ageing or her diabetes. Her symptoms continued.

Diagnostic Findings

On examination, the small joints of both hands and both wrists were swollen and stiff.

This pattern stood out to me. Morning stiffness, swelling in many small joints, and pain in both hands are signs of joint inflammation (inflammatory arthritis). Wear and tear from ageing does not usually look like this. So I ordered blood tests to check for inflammation.

Two blood markers of inflammation were raised: ESR (erythrocyte sedimentation rate) and CRP (C-reactive protein). These go up when the body is inflamed. Her symptoms, examination and blood tests together pointed to rheumatoid arthritis (RA).

RA is an autoimmune disease. This means the immune system attacks the body’s own tissue by mistake. In RA, it attacks the joint lining (synovium) and ligaments. This causes heat, pain and swelling. Over time, it can damage the joints. Genes play a part. RA can also affect the knees, hips, ankles and elbows.

This shaped my plan. Painkillers had not helped because they do not stop the immune attack. To protect her joints, I needed to calm the inflammation and settle the immune system.

Treatment Approach

  1. I explained what RA is, and how it differs from the general aches people call “rheumatism”.
  2. I prescribed a low dose of a steroid (corticosteroid). It calms swelling fast while the long-term medicine starts to work.
  3. I started a DMARD (disease-modifying antirheumatic drug). This type of medicine slows the immune attack on the joints. It can take several weeks to work fully.
  4. I planned regular reviews. RA is a long-term condition. Symptoms can come back if treatment stops.

Outcome

After two weeks of treatment, the pain and swelling in her hands and wrists had settled. She went back to her usual daily tasks and work. She stays on treatment to keep the RA under control, as it can flare up again.

This outcome reflects one individual case. Treatment suitability and results depend on each patient’s specific diagnosis and clinical assessment.

Ask the Doctor

Q: What is the difference between rheumatism and rheumatoid arthritis?

A: “Rheumatism” is a loose word for general aches. People often blame it on cold or damp weather. It usually eases with simple painkillers and exercise, and is not usually linked to joint damage. Rheumatoid arthritis (RA) is different. Here the body’s own immune system attacks the lining of the joints. This causes morning stiffness, swelling and raised inflammation levels in the blood. Over time, this can harm the joints, so RA needs medicine that calms the immune system, not just painkillers.

— Dr Bernard Lee Mun Kam, Pain Specialist