Psoriatic Athritis

[Cate1980]

Just been diagnosed with Psoratic arthritis. Very unsure about what it is, dont have a rash and worried about starting any meds, Has anybody eles have PA with out a rash.

[earthwitch]

Just think of it as one of the spondyloarthritis group of seronegative inflammatory arthritis,  that tends to attack entheses (points where tendon joins onto bone) rather than the synovial surfaces of joints (which RA does).  Its still an inflammatory arthritis, and still needs treating, though there aren't so many options before you get to anti-tnfs as DMARDs don't really have a disease modifying effect on spondy.  A couple of them are worth trying though, as particularly with PsA, they can have a good effect.  If you need more information, then check out the National Ankylosing Spondylitis Society (which is to spondy what NRAS is to RA).  NASS have an excellent phone helpline as well.

[Hidden]

Hi, I have PsA.  I was diagnosed back in 2012.  It can be an absolute swine to diagnose so you've done well!  I hesitate to say 'congratulations' ... but you might congratulate yourself in time because the meds can work very well.  

I had psoriasis for about a decade but it cleared up at least 20 years before my PsA diagnosis.  In 2012 I had a tiny patch on my elbow but the rheumy pounced on a toenail that I thought had a minor fungal infection ..... psoriatic disease often affects nails.  Last year I had a full-on psoriasis flare but that was the first one ever & I was 59.  

I agree with earthwitch that DMARDs don't necessarily work for PsA as well as they may for RA.  However I did find that Methotrexate helped considerably.  Humira (a biologic drug) has worked wonders though.  

[ITYFIALMCTT in reply to Hidden]

Daft question but, postle2, might I ask if it was just the one toenail? I'm waiting on the results of some recent blood work but I've had a rash in my scalp for a while and just the one toenail that looks like it has a fungal infection (for 2 years almost). I was wondering about PsA if my blood work is seronegative for RF etc.

In answer to OP - I'm wondering if I need to rule out PsA because altho' I don't have a history of psoriasis, I did develop a scaly rash that hasn't cleared from my scalp neckline in 3 years and I've had something that might be a fungal infection or a single psoriatic toenail for 2 years. And sometimes it seems as if PsA manifests such that the arthritis appears before the psoriasis - it might be that this is happening to you?  

I hope that your Rheumatology team can put your mind at rest about the medications. Best Wishes.

[Hidden in reply to ITYFIALMCTT]

Yes, surprisingly perhaps it was only one toenail that grabbed the rheumy's attention at first & seemed to clinch the diagnosis in her mind.  Then she did decide that another was psoriatic too.  She was a foreign locum, travelling the world, but very experienced.  So as her english wasn't perfect some of the things she said were interesting.  When I suggested that my toenail was just a bit fungal, she said 'no, it is very sick'.  Well it is still hanging on in there, so I wouldn't say it was as sick as all that.  But my PsA diagnosis has been confirmed as '99%' certain by my current rheumy who is a real star, probably up to 100% since last year's all-over psoriasis outbreak. 

The impression I get, though that is all it is - a strong impression - is that PsA is being diagnosed more frequently where once a diagnosis of 'seronegative RA' might have been made.  It's essential to point out your rash and your dodgy toenail to your rheumy, and no harm in asking whether he or she is considering a dx of PsA.   

[Hidden in reply to Hidden]

Also, I don't think there is such a thing as a 'daft question' about PsA, it's a funny disease with odd symptoms.

[ITYFIALMCTT in reply to Hidden]

Thank you for your responses: I don't have a rheumatologist as yet as a GP ordered the blood tests. I'm just preparing for a discussion about them, whatever the results might be (hence my interest in what to ask about if I have seronegative results and my GP considers that to be the end of the matter).

I like the account of your travelling rheumy - she sounds delightful.

[linda-5502]

Hi I too have PsA and in 2013 was diagnosed with that and RA. I was getting terrible itchiness and blister like spots coming up but since on Leflunamide tabs it has almost stopped so keep your chin up and I am sure your GP or rheumy will sort it out. I believe it is a symptom of PsA.

[dapper]

I know of 2 people that have psa without having psoriasis ,i have had psoriasis since i was about 6 ,now 62 ,got diagnosed with psa 6 years ago ,now on biologics ,they have helped a lot ,so does excercise ,

[Barrister]

I have PsA, diagnosed in 2014. I don't have psoriasis but my middle son has severe psoriasis. I held out on taking medication because of the side effects - I was terrified to be honest. But since diagnosis I've tried MTX, sulpahsalazine, Humira ( for 14 months but developed antibodies to that ) and now am on Enbrel. I was also diagnosed ( around the same time ) with Lymphocytic Colitis which the rheumatologist said confirmed the diagnosis. It is scary developing all these problems but the biologics make a big difference. Hope you find the right medication for you quickly. Clemmie 

[flow4]

I have PsA. I don't have 'classic' psoriasis, although since diagnosis I have learned that some minor skin problems I thought of as just 'random' were/are in fact psoriasis. They are very occasional, very small, unremarkable patches - though sometimes painful - which I thought were caused by things like allergic reactions, too much chlorine, not drying myself properly, etc... My dx was initially inflammatory arthritis, so I was put on Hydroxychloroquine, which ironically triggered a psoriasis flare that changed my diagnosis to PsA. I started methotrexate 6-7 weeks ago, but can't tell whether it's working for me yet, because I had a depo steroid injection at the same time that worked wonderfully! I was very scared too, but so far the side effects of the MTX have been very mild and not hard to deal with.