Psoriatic arthritis?

Can anyone tell me more about psoriatic arthritis? I had never heard of it until joining this forum. The reason I ask is that I recently went to the doctor as have been really suffering with unbearable pain in my feet and toe joints and my knees are getting gradually worse. I was fobbed off with a blood test, which came back clear. I have since been told that there are certain types that don't show up in blood tests as there aren't indicators in the blood. Is this the case with psoriatic arthritis? I have had psoriasis since childhood so it has got me wondering? I also have a family history of arthritis. There must be some explanation for my pain. She's made me feel like I'm making a big deal of nothing but it really is bad. Any advice much appreciated. TIA

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  • I got sick suddenly in May with every joint from ears to toes in agony. I had most pain in my wrists but my feet hurt terribly sometimes so i do empathise.

    My blood tests are almost completely normal too but my Doppler scans showed pretty severe inflammation (synovitis) in my hands, so I was diagnosed probable psoriatic arthritis based on family history. (I don't have psoriasis)

    She hopefully did Rheumatoid factor anti ccp, ESR and CRP at least. RhFactor and anti ccp is likely to be normal in PsA but they have to try to exclude Rheumatoid arthritis. Most people with inflammatory arthritis such as RhA or PsA will have raised ESR and CRP (inflammatory markers) but mine are never high, so it still doesn't exclude it.

    Do you have a dermatologist?? They may be better than GP as they will definitely have seen PsA ...otherwise ask for referral to rheumatologist despite your bloods. PsA can be very damaging to joints very quickly and its so common in psoriasis she really should give you the benefit of doubt and allow a specialist to do the correct scans etc.

    I am on medication now and hugely improved, so glad I fought for my referral.

    Good luck!

  • As you have Ps request your GP sends you to a rheumatologist as they are the only people who can decide that you have PsA. A good test is look at your fingers and toes are the look of them "sausage" shaped, are you nails on both have any "pitting" in them, are the nails "thickening", all are good pointers a rheumy would look for.

    Blood tests will not show up for actual PsA but rule out other possibilities, although I believe there maybe one test that can help decide but generally it's the look of where your flaring, along with X-rays. PsA shows up different on these to other forms of Arthritis.

    Arthritis Reasearch Uk, provides up to date information along with drawings of where the usual sites where your joints could have it, these are not all but it's a starting point. Similar to if you were looking up Ps, they say the norm is elbows and knees, whereas with PsA, it's fingers, toes and heels, but can effect most other parts if your body along with your ligaments. As once inflammation sets in it can effect quite a lot of your body.

    Hope this helps to understand a bit more of PsA.

  • Most my blood test come back normal but when doc did antibidy and vitamin D one they was abnormal.

    Ad ask him to check ya antbides and vitamin levals .. as the not coverd on normal blood test

    Since i have been taking vitamin D my legs joints have not been as bad

  • You definitely need a Rheumy for PsA management. It's close to RA in severity and you don't want it ignored or missed. It affects your joints, ligaments, tendons, and all connective tissue including muscle. It can be quite serious if not held in check. I take Araba/leflunamide. I have not too much pain to complain about, so I'm happy with the drug. I do have a lot of problems with my fingernails and toenails being weak and tearing easily, growing extra thick or thin, or concave, tearing into the quick and generally needing lots of extra attention to look decent.

    Rheumy can diagnose PsA even when there's not much to go on, as others have said, even by the pitting in your nails. It can be a silent menace, causing damage while you delay getting it diagnosed, so please don't delay. This is not something to ignore. Hopefully your CRP or Sed Rate will be elevated, or antibodies will be tested. I have minor joint pain from the PsA, probably because mine was caught very early. I do have it where arthritis is in my spine. Take care.

  • Thanks all for your responses. They are all really useful. I am definitely going to go back to my Doctors. Hopefully I'll get a more sympathetic one this time who actually listens!!

  • Hi!

    there's a very useful book about psoriatic arthritis called 'Psoriatic Arthritis - the facts' by Dafna Gladman and Vinod Chandran. Dafna Gladman is a rheumatologist at the Toronto Clinic in Canada, a world research centre for Psoriatic Arthritis. This is what it says about PsA and inflammatory markers:

    " ...... there is to date no diagnostic test. The acute phase reactants (erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) are often normal. These are raised in less than 50% of people with psoriatic arthritis."

    So in other words less than half of people with psoriatic arthritis will show any signs of inflammation in blood tests (ESR and CRP measure inflammation). And there aren't any other blood tests that can confirm PsA.

    You do need to start with a blood test though, so your doctor was right to do this. Sometimes the inflammation does show up (I was 'lucky', mine did) and of course the blood test might show something that suggests RA or another issue.

    If a person has psoriasis and joint pain they most definitely need to be checked out for psoriatic arthritis. You've started the ball rolling by getting a blood test. If your doctor isn't taking things forward you will need to persevere to keep the process going.

    Have you got any even slightly dodgy fingernails or toenails? A very high percentage of people with PsA (about 80%) have nail psoriasis. Do you have any joint swelling? Do you have any tendon pain such as on the Achilles tendon at the back of your ankle?

    If you do have any swelling, take photos on a phone for future reference. And even if you don't have swelling etc. I'd urge you to go back to your GP with your 'polite but firm' face on and say "I've had psoriasis since childhood, I've got persistent joint pain, I'd like to request a referral to a rheumatologist".

    If she won't oblige there are things you can do, but I'll shut up now & keep my fingers crossed for you!

  • I am new to this as well I was diagnosed with Osteoarthritis in 2012. In my hands in May of this year my hands and other joints became painful my doc referred me to the hand clinic. They referred me to rheumy clinic to see if it was just osteo or RA found out it was PsA and psoriasis. I had a bit of psoriasis on my elbows but I thought it was just dry skin now I have it in my scalp. I don't know of anyone in my family with this. I go back to see the rheumy clinic in January to see the consultant and I have a lot of questions to ask him. Take care xx

  • I hope it goes well bless23. I would be very interested to hear back from you. X

  • hi

    I've had psoriasis since 12y old it's been very bad at some stages in life pass 10 years very much under control. Now for 3years sufferig with hip and knee pain blood test normal as X rays shows normal changes age 45 now. Dr say can't be any kind of arthritis or psa pain in both elbows now at times very servere will have to follow up at Dr for referral praying he will give

  • Ask your doc for referral to rheumatology clinic you will be able to find out if it is PsA

  • Yes I definitely think you should ask to be referred to rheumatology. It would appear that GP does not diagnose these conditions and I've been told by both family members with arthritis and members of this forum that it often does not show up in blood tests. Don't give up. X

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