itchy red, warm scalp. Also psoriatic or rheumatoid if you are sero-negative?

[Mozart150]

Hi guys

I'm sero-negative. My big joints were affected first - had right knee replacement and hip replacement six months later aged 54 and although initially recovered well from knee replacement - couldn't sit to stand from chair, loo etc and couldn't get of crutches. Had lots of symptoms but still took ages for my GP to refer me to get diagnosed 😬 Because I had had hip operations as a child( as was born with a dislocated hip that wasn't detected until I had walked on it ) it kept being put down to osteo.

After lots of flares, steroids and meds and left knee replacement two months ago my last blood test showed CRP to be 1 and ESR to be 20 - think that the best ever!

I have come off Naproxen but still on Cocodamol 30/500 - my feet are the most painful. The last bad flare I had was when I was off Barcitinib for two weeks either side of knee replacement and day after booster - I could hardly lift my right arm - my shoulder was more painful that my knee but thankfully I had already got from Morphine from GP. I started back on Baricitinib and over time settled - thankfully not needed steroids as I usually do.

In the past one consultant told me I probably had psoriatic arthritis as my dad has psoriasis. When off Baricitinib this time I did have three patches which looked a bit like psoriasis but not sure.

This last month I've had constant itching off my scalp - the crown area red and warm - GP gave me Betnovate and I was taking Piriton. Twice I've been to the hairdresser's but it still red and warm so haven't had my colour done and now very grey !! I had this scalp itching before but usually when in a flare but wasn't flaring this time.

My feet are painful - underneath and on the sides and feel weird at night - don't really know how to explain it - they feel bit and tingly.

I have rheumatologist appt next week and am going to see if he will request scans of feet and hands and possibly right arm/ shoulder. Left thumb bent and cannot use with swollen joint and swollen thumb joint. Will get his opinion on my scalp.

Has anyone else had the scalp problem ? It's not flaky like psoriasis but was constantly itching (that has stopped now ) red and warm. Also - how can psoriatic and rheumatoid be differentiated if you are sero-negative? I know the treatments are often the same although i don't think Baricitinib is licensed for psoriatic.

Nobody initially took me seriously as they said rheumatoid was symmetrical and affected your hands first (mine were last). Iv'e learnt along the way but will stand up for myself now!!!

Thank you for any advice - I know it's not medical and will be seeing rheumatologist next week.

[Hidden]

With the caveat that I’m not medically qualified. My understanding is that a diagnosis of PsA over rheumatoid is usually based on a combination of clinical features, disease presentation, blood work, and relevant history. Rheumatologists really are more like medical detectives than anything, which is partly why diagnoses can change over time as they’re given more evidence to work with.

Whilst there are almost always exceptions in medicine, generally speaking, PsA has an asymmetrical presentation, whereas RA is most often symmetrical i.e. when a joint first becomes effected in RA, it’s usually the pair, so both knees, both wrists etc. In PsA, it’s commonly only one joint to begin with, although the other may join in further down the line. There are other features that are much more common in PsA, such as dactylitis (‘sausage’ fingers or toes), and enthesitis, which is inflammation of the sites where tendons and ligaments join bones. Spinal involvement is also much more likely and common in PsA than RA. Swelling and pain during flares may be more transient in PsA, moving between joints day to day, and redness and heat may be absent. Whilst seronegative only refers to normal RF and anti-ccp, a large proportion of PsA patients will also have normal esr and crp even at the height of a flare, which is part of why getting a diagnosis often takes years longer for many PsA patients than even those with seronegative RA. The history then adds extra significant weight, including first line relatives: I had a single patch of psoriasis on my calf for a few months as a teen, and now realise I’ve had bouts of mild nail psoriasis over the years, but even without that, with an asymmetric presentation and spinal involvement, my dad’s awful toenail psoriasis would have been enough to get me the ‘likely PsA’ label I was given when rheum finally diagnosed me three years ago. After 20 years of active disease.

Bottom line, in the absence of positive blood work, the distinction between RA and PsA (or any of the spondyloarthropathies) is usually down to the pattern in which symptoms initially emerged, including whether you have any of the more ‘tell-tale’ features like dactylitis or any spinal involvement, and personal and family history of psoriasis. The rheumatologist has to weigh all of these factors up and decide on the balance of probabilities what the more likely diagnosis is, which is why diagnoses can change, particularly if a patient is sent to them when symptoms are still mild and limited to only one or two joints. It’s also worth pointing out that skin psoriasis usually tends to persist without treatment, so flaky skin that clears up spontaneously within a week or two, even if it reappears periodically, is unlikely to be psoriasis: my scalp is currently itchy and flaky, but it’s dermatitis. By comparison, my experience of plaque psoriasis was that it was very scaly, and both itchy and sore, but there are several different types of psoriasis and they all present differently.

Hope that helps a little bit.

[Mozart150 in reply to Hidden]

Thank you for taking the time to reply - it was very informative and helpful.

[Hidden in reply to Mozart150]

Hi Mozart 150,

I don't know if I can really add much more to Charlie_G's incredibly thorough coverage of the key differences between the conditions but hopefully these resources will also be of help to you.

- nras.org.uk/resource/making...

- nras.org.uk/resource/possib...

- labtestsonline.org.uk/condi...

- versusarthritis.org/about-a...

- nras.org.uk/resource/what-i...

- nras.org.uk/resource/managi...

- nras.org.uk/resource/managi...

You could also have a chat to your local pharmacist about your scalp and see if they have any suggestions as to its cause/ how to help.

I hope you find this information useful and wish you all the best. Should you require any additional information or support please contact our helpline on 0800 298 7650 (Mon-Fri, 9.30am-4.30pm) or email us at [e-mail]

Best wishes,

Hannah - NRAS Information and support coordinator

[Hidden in reply to Hidden]

Also:

- nras.org.uk/resource/ra-foo...

[Mozart150 in reply to Hidden]

thank you so much will have a look at all this x

[rabbits65]

I am sorry to read you have so much pain. I just wanted to say that I too have the tingly feet some nights, and they feel weird and hot. I believe it’s called hot feet syndrome where they go all red on the balls of the feet, I have read a lot too about peripheral neuropathy which I believe is where the tingly feeling comes in our feet, I want try to find out a bit more about the neuropathy as it can be very uncomfortable when your trying to get off to sleep and all this starts happening to your feet late at night. How often do your feet do this? I wonder if there is any treatment.

[Mozart150 in reply to rabbits65]

Hi rabbits65 Thank you for replying. I am seeing rheumatologist Wednesday so will discuss and also get the podiatrist to check too - I think it's nerve conduction studies. It seems to happen most nights to varying degrees. I will post what I find out or if they refer me for tests .

[rabbits65 in reply to Mozart150]

good luck with anything you find out, I am interested in hearing any information or results.

[Mozart150 in reply to rabbits65]

👍 will post