Symptoms of PsA

[looby24]

Hello

I wondered if anyone could share with me the symptoms of PsA? Although I have been told that I've probably had this for a while, the only sign, for years, was two slightly swollen toes which at times were a little sore. Well that's what I thought, until I started to realise that some foot pain that started a few years ago, cost me a small fortune in physio, soles, creams, treatments etc, all with no benefit, must have been PsA making a grand entrance.

However now the pain I get is really weird.

Worse first thing in the morning, but not always - takes me a good half hour to loosen up my back and my ankle

During the night I get these painful spots in my legs - not in the joints. but half way up the leg and the pain feels like it's in a spot in my bone.

Burning feeling in the ankles and metatarsal area.

After sitting for a while (like in a car journey or watching television ) I literally have to limp around for 5 minutes before I can walk

The way the pain comes and goes is very strange - occasionally there is no pain at all and I can walk as nothing was wrong

Is this what PsA feels like? Is it better to move as much as possible or is it important to rest? I have not had a chace to ask the doctor.

Does cold weather make the pain a bit worse? Is it a bit like psoriasis that can generally improve in sunny/warmer weather/ sunshine?

Thank you

[Greenmil3]

looby mine makes me feel like a fake sometimes as I have entithesis with mine but it affects different areas. My feet are agony some days and a new symptom is like cramp but only in the main tendon in my foot over the arch can happen whenever. I also get rapid pain in my left knee and right thigh that will make me collapse. I can manage around the house but if I go out I’m in a wheelchair as apart from the pain I get fatigued walking too much, sleeping is no fun as I get back and hip pain that I’m waiting for further diagnosis for. To sum it up there are so many variations of symptoms that almost all have some slight differences. Sorry not to be of more help.

[Batty1 in reply to Greenmil3]

You and me are in the same boat …

[looby24 in reply to Greenmil3]

I also get this pain over the arch of my foot. I wonder if it could be due to a bone spur, which I understand is one of the issues with PsA. It's the pain that is not near joints that I find the weirdest.

[Soreknees2016]

My experience is quite different, as seems to often be the case with PsA and other rheumatoid conditions. When I have a flare, it starts in one ankle or knee, with such intense pain that nothing relieves it, and I can’t put weight on that leg or walk. There’s no redness and very little swelling - just pain. It can come on overnight and last for days or weeks, then just disappears, only to reappear in another joint, sometimes, but not always, affecting more than one joint at a time. Fortunately, having been on methotrexate then Sulfasalazine, I haven’t had a flare for a number of years, and I fervently hope that it stays that way! The psoriasis only ever affected the palms of my hands and the tops of my feet, and severely damaged some of my fingernails, but actually started years before the joint pain, but again, it’s controlled by the meds.

It took a long time to be diagnosed - I think I first experienced joint pain out of the blue in 2006, but despite many GP appointments and painkillers, it was only after I moved to a new area and finally got referred to rheumatology around 2012 that I got the PsA diagnosis. My flares were very intermittent at first - sometimes only once a year/18 months, so I wasn’t offered DMARDs until they started to become more frequent, which on reflection may not have been the best thing, as my joints may have already been damaged by that time. I have also had Bakers Cysts in both knees, which seems to have disappeared of their own accord!

I suppose PsA is one of those conditions that presents in different ways in different people, and your symptoms are possibly just variations on that theme. You don’t say if you are under the care of a rheumatologist or on any meds but perhaps your range of symptoms needs to be investigated further. Best of luck!

[looby24 in reply to Soreknees2016]

Thanks. Yes I had my first ever rheumatologist appointment just a few weeks ago and have started methotrexate, reluctantly as I have liver issues. The pain that I sometimes feel at rest (at night) randomly half way up my thigh for example, I worry about because if feels like bone pain. I had thyroid cancer and I would hate for any recurrence /metastasis.

Before I got round to seeing a rheumatologist and diagnosed with PsA I was diagnosed by an orthopedic surgeon as having an issue with the veins in one of the bones in my foot having gone haywire and causing pain. Been trying to get rid of that for a while but it's not shifting. I was told it could be fixed but it's still there. Not sure it's related to PsA - I find that a major issue with traditional medicine - every specialist looks at his/her on bit and no one has an overview

[Soreknees2016 in reply to looby24]

I don’t wish to cause alarm, but after being on methotrexate for 3/4 years, I was diagnosed with liver cirrhosis, despite never being much of a drinker. I do have diabetes (T2j and had previously been told I had non alcoholic fatty liver, so the potential for further liver issues was always there, but my rheumatologist was clear that the methotrexate was a major contributing factor and immediately took me off it.

Since I replied earlier, I have had a look at your other posts and seen your other health issues, so would tactfully suggest that you might want to raise concerns about mtx with your rheumatologist - if you’ve only been on it for a short while, it might be prudent to change meds now rather than further down the line. Just for info, Sulfasalazine has been as effective as methotrexate for me, so there are alternatives.

Also, do you get regular blood tests? I see you are in Italy, so not sure what monitoring is in place for you. I started with fortnightly GP tests, later switching to 6 weeks, then 3 months, which the rheumatologist had access to and which I think was what raised red flags about my liver.

[Lulla in reply to Soreknees2016]

Thank you. You are not the first person who is warming me about methotrexate and I am still uneasy about taking it. I kind of had it in my mind that one had to go through trying mtx before being offered something else but your reply is the tipping point. I’ve only taken my second injection so far and I think I’ll stop. If necessary find another rheumatologist. It just makes me a bit angry that the doc would not start with something else given my current liver issues.

As a first step I’ll ask if he can prescribe me an alternative.

Is the one you are taking now a biologic?

[Soreknees2016 in reply to Lulla]

I think that’s wise. Sulfasalazine is a DMARD (Disease-modifying antirheumatic drugs), like methotrexate, as are hydroxychloroquine and leflunomide, so in the UK NHS, you could expect to try some of these, or a combination of them, taking account of any contraindications with other conditions before being offered biologics, and many people find one or more that suits them. They do all have various pros and cons as you would imagine, so any doctor should definitely be looking at your other health conditions before prescribing, and then monitoring you closely afterwards, so you’ve every right to be angry. Also, they can all take several months to be effective, and not all drugs work for everyone, so it can be very much a case of trial and error, during which time other conditions can be exacerbated.

I hope you get a quick and satisfactory resolution to the mtx situation - you might also like to have a look at the NRAS forum on HU, which covers many of the rheumatoid ‘family’ of conditions and has a very active membership, which I have found very helpful.

[Lulla in reply to Soreknees2016]

Thank you so much. That’s very hepful

[Batty1]

I think anyone with Psoriatic Arthritis will have different experiences …. I started with PSA pains 7 years ago (Enthesitis) or Tendon arthritis … I hobble constantly now. I did start out like what you described off and on type of a thing… My knees don’t straighten fully anymore which kills when you walk or stand too much and my hands don’t function so well either so opening doors, bags or griping pans are a huge problem and after sitting or standing too long/much just sends my body pain into overdrive …. My shoulders are currently acting up which leaves me with numb arms and hands….This disease sucks and eventually sucks the life right out of yeah… agh

[looby24 in reply to Batty1]

I'm sorry to hear about the extent of the progression. Have the biologics not managed to stop progression or did it all happen before you started taking biologics?

[Batty1 in reply to looby24]

No biologics haven’t 100% controlled my PSA and Im on 2 (Cosentyx and Otezla)