Psoriatic Arthritis

[Snowglobe]

Hi,

I'm in the process of confirming this diagnosis. The first rheumatologist, during yearly visits, has said no, no, yes, and now back to no. I have been told to take Tylenol Arthritis, after finding that I was not able to continue the two different NSAIDs that he had originally prescribed (bleeding). Now he refuses to prescribe anything else, as he has decided that I do not really have PsA. So I'm off to a specialist clinic for PsA in another city (Toronto) for an assessment.

I'm at a loss. What should I be asking about now?

I've been told by my GP that I have inflammatory markers in my blood. I have some joint manifestations as well (and skin). The pain, stiffness and fatigue are there. My quality of life has accelerated downhill in the last few years and I can barely walk anymore.

Is there a test that I can ask for that would definitely confirm PsA once and for all?

[vascy_errol]

Snowglobe

I am going through the same questions as you at the moment with lots of joint pain, stiffness and fatigue. I have chronic plaque psoriasis managed by Humira (Adaluminab) and also HSP/IGA vasculitis (although deemed as in remission), managed through Azathiaprin solely now but was managed through steroids as well initially. It was after I reduced below 20 mg of the steroids that my psoriasis came back ( I had paused Humira at onset of the HSP) and also the joint pains, stiffness and fatigue started to appear. That was back in Dec 15 and I was referred to a Rheumy, eventually seeing him for the 1st time in Feb 17 where I had bloods done plus x-rays of joints. I go back for the diagnosis next week.

I have done some digging to be informed for that appointment, and the NICE guidelines that the UK National Health Service follow are available on line here:

nice.org.uk/guidance/cg153/...

At para 1.2.2 they talk of a Psoriasis Epidemiological Screening Tool (PEST) assessment and there is a further link in the NICE guidelines for this (not been there yet). Also within the NICE website there are also a host of other articles, facts and inforamtion on PsA - sorry that I cant be more specific, but I haven't had the time to search through it yet!!!

Good luck in your quest for a diagnosis and treatment.

Andy

[Hidden]

The Toronto clinic is world class I believe. Expert rheumys tend to lead appointments so that you don't have to!

There are no tests that confirm PsA 100% which is why it's so good that you're going to a specialist centre, it mainly comes down to the doctor's clinical judgement and experience.

One very common symptom associated with PsA is nail changes. About 80% or people with PsA will have some form of nail involvement. So if there's anything odd about your nails at all, do flag it up. I had thought my slightly manky toenail was fungal but tests confirmed that was not the case and it therefore helped my PsA diagnosis. You don't say if you currently have psoriasis .... it's important to mention any skin rashes, even if they happened years ago, even if they were not diagnosed as psoriasis. Any close family members with psoriasis are also possibly significant.

To be honest you sum up your situation fairly succinctly. If you can detail stiffness (including duration of any morning stiffness - if it lasts all day then say so), areas of pain and severity of fatigue then that may well be all you can reasonably be expected to do. If you suspect any swelling then show the rheumy. When my knees first started to swell I thought they were just getting fat .... which doesn't really happen in isolation I guess!

Good luck. Sounds to me that if you do have PsA then you're on course for the best outcome.

[Snowglobe]

Thank you both, vascy_errol and postle2.

I've now had my first appointment and I feel that it was quite thorough. I was sent for blood work and so many x-rays that I thought that I must have been glowing in the dark afterwards (hands, feet, back, neck, one shoulder - the knees and hips already done beforehand).

I did not think of mentioning the previous rashes. But I do have photos of one of the rashes and of the sausage toes, so I'll bring them with me for the follow-up appointment.

[Seenie in reply to Snowglobe]

You are attending what is probably the best PsA clinic on the planet. They will get you sorted. Going there changed the course of my disease and my life. Please keep us in the loop!