Psoriatic arthritis

[Snowy86]

Hi everyone.

So, after a year and a half of worsening joint pain and numerous tests, a rheumatologist has diagnosed me with early psoriatic arthritis and prescribed methotrexate.

My concern is that nothing whatsoever has ever shown up on any tests. ESR and CRP are low (lower than normal actually). Normal xray and no synovitis on ultrasound - although they only scanned wrist and MCP's, not the PIP joints that actually swell and cause the most pain/stiffness. Other than weak ANA and occasional low WBC, nothing has shown.

Could this actually be PSA or is utterly something totally different? Will post this on the Psoriasis forum as well as I'm not sure where would be best to get advice.

Thank you.

[J1707-]

after 6 years I’ve been re diagnosed with inflammatory arthritis as I suffer RA/Psoriatic arthritis and spondolarthitis . I’ve never had any symptoms medication with my bloods it’s been symptomatic. I don’t really have joint pain . I have lots of swelling and more tendon/ bursitis and enthitis pain . I suggest you keep a diary and take photos. We are all different.

[Kentishman]

Twelve years with PsA and never had any markers show in blood tests. PsA is a strange condition. It can start with joint pain (sometimes no evidence on x-ray) and then move to tendons, muscles and cartlidge over several years. It can move around the body and affect eyes, ears, etc. I started with methotrexate. then biologics, then jak-inhibitors. I’ve had periods of remission and some treatments have worked for periods, others not. Unfortunately, you learn to deal with the pain whilst you seek the treatments that work best for you. For me, and others, stress is a trigger so I have learnt to pace myself, rest when needed and avoid stress in my life, where possible. Prednisolone helps manage flares. If you have PsA you will probably become an expert in your condition - which is not well understood - and what works for you. Hope this helps,

[Bakerannie]

I, too, have been diagnosed with Psoriatic Arthritis, and to mimic the others, my inflammatory markers have never been elevated. The only time I ever had a rise in CRP was a year ago when I was hospitalized with an unrelated bowel infection. I think what is difficult for me, and perhaps others have felt this way, is that from time to time I think that the Rheumatologists may have been mistaken, and maybe I'm taking all these medications for nothing. Then the tendonitis rears its head, and I can barely make it from lounge to toilet. Of note, I did have tenosynovitis, tendonitis and bursitis on various ultrasounds prior to diagnosis. It's a strange disease, because joints may not be overtly swollen, but tons of inflammation in the tendons and entheses. I've found JAK inhibitors to be most effective, with MTX, Hydroxychloroquine and a sprinkling of Pred for good measure.

[rmros in reply to Bakerannie]

This all sounds very familiar. Without a definite marker like the antibodies you get in diseases like RA or Hashimoto's, I keep having my doubts about diagnosis even though it's the only thing that makes sense.

It's interesting that you also benefit from hydroxychloroquine because the textbook line is that it's not useful for PsA but it was the first thing I was prescribed (when I had a non-specific diagnosis of inflammatory arthritis) and it really helps me feel better. I take Cosentyx and methotrexate now as well, but I still wouldn't be without the hydroxychloroquine.

[LinaM]

I saw a private rheumatologist who diagnosed me with PSA . My bloods are also normal but I have extensive damage to the joints in my fingers. I have started to developed skin issues and also have problems in my back and hip , but nhs rheumatologist almost dismisses those issues. As always , it’s a take drugs and see approach as far as I can tell. The NHS rheumatologist describes it as being under the “ inflammatory arthritis” umbrella and it’s all treated the same .

[rmros in reply to LinaM]

Even after I was diagnosed with inflammatory arthritis it took several years to get someone to take my back/hip pain seriously. There seemed to be some notion that women don't get inflammatory back pain and that's bollocks. Eventually I had the right scan, a very specific type of MRI is needed, and they found bilateral sacroillitis and the right diagnosis does matter because it's *not* all treated the same.

The NHS pathways to certain treatments are different - I wouldn't have qualified for biologics under an RA pathway but I do under a PsA pathway - and there are some differences in which medication works best as well as affecting access to treatments like hydrotherapy.

[LinaM in reply to rmros]

Thanks for that ! …, I did tell the nurse on my last check up that I had developed some skin symptoms and pointed out that I think it’s PSA . Hopefully when I see the rheumatologist he’ll take that on board

[cyberbarn]

As others have said, my bloods are always pretty much normal. When my 'joint pain' started ramping up, having joint problems on and off over the years due to hypermobility, I used a symptom matrix which is where you put all of your symptoms down one side of a table, and across the top the different conditions that you either have or might have. Then tick the boxes of the symptoms you have. At the bottom add up the totals. For me I have hypothyroid disease, and EDS, so they had the most ticks, but the next one was PsA (table above is just the first page to give an idea of how to set it up). The matrix is a personal version of the matrix in this paper:

onlinelibrary.wiley.com/doi...

My GP looked at it, listened, and agreed. The first rheumatologist should have had his hearing tested as he didn't seem to be able to hear anything I said, but the second opinion rheumy eventually agreed it was likely PsA.

Sadly, having only examined my hands, she says I don't have enough joints involved to allow me to try anything beyond methotrexate which make me really ill.

It did validate all those physio and doctor appointments where I said, 'But the pain isn't inside the joint, it is outside it. It seems to be at insertions and origins of tendons.' where the clinicians shrugged and said, 'No idea what that is.'

a table with possible conditions across the top and patient symptoms down the side.