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Old 07-04-2004, 01:17 PM   #1
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psoriatic arthritis

My Dr suspects either rheumatoid or psoriatic arthritis, I have had no tests to confirm either. I had a negative RF. I don't have a lot of pain other than in my spine and back. Things like sweeping/mopping or standing still really hurt my back, and some mornings I need help getting out of bed. After about 30mins after getting out of bed, I feel better. Other joints are a bit stiff off and on but I have no swelling or redness in any of my joints. I do have psoriasis. Does this sound familiar to anyone? Which if any does it suggest?
Oh, I have no family history of arthritis, if that makes a difference.
Thanks
Abby

 
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Old 07-05-2004, 12:50 AM   #2
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Re: psoriatic arthritis

You could have some degenerative disk disease going on depending on your age and all. Psoriasis can cause arthritic pain in joints. Could be the sweeping mopping side to side motion gets it flared up, it does mine. I'd find out just what is going on, may be nothing more than muscle strain or it could be disk problem as well as a number of thing. As for history in your family, arthritis doesn't have to be in the family to get it, I have had it for 25yrs and I'm the only one in the family who has it, my mom is 74 and no joint problems, mine stem from other medical conditions and trauma to the joints.

 
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Old 07-05-2004, 03:51 AM   #3
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Re: psoriatic arthritis

Thanks for your reply. I am 30yrs old, I have had lower back pain since I was 17. It has only been the past year that my spine has been causing me pain. The extreme stiffness in the morning started about 4 yrs ago. I don't know what the cause is, I can't think of any specific trauma to my back or joints. It definately isn't wear and tear because it has slowed me down quite a bit. My posture in getting increasingly worse thought which may have contributed to the spin problem. My Dr is sending me for some tests(not sure what kind yet). Thanks again

Abby

 
Old 07-05-2004, 07:48 AM   #4
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Re: psoriatic arthritis

I would definately suggest you have an MRI or xray of your spine, preferably an MRI. You could have some degenerations or even a herniated disks in there causing you so much pain.

A lot of people suffer from back pain with no history of problems, I think its often just natural as we grow older from wear and tear or just a weak back to begin with, particulary if you are tall. One thing I do know that can cause it is an improper gait or imbalance of the hips, that's what happened to me. I have one leg 1" shorter than the other (used to be 4" at birth) and it has caused my lumbar to herniate. Believe it or not wearing heels regularly can do the same thing.

oh the things us women put ourselves through

 
Old 07-06-2004, 06:15 AM   #5
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Re: psoriatic arthritis

Quote:
Originally Posted by abbygirl2
My Dr suspects either rheumatoid or psoriatic arthritis, I have had no tests to confirm either. I had a negative RF. I don't have a lot of pain other than in my spine and back. Things like sweeping/mopping or standing still really hurt my back, and some mornings I need help getting out of bed. After about 30mins after getting out of bed, I feel better. Other joints are a bit stiff off and on but I have no swelling or redness in any of my joints. I do have psoriasis. Does this sound familiar to anyone? Which if any does it suggest?
Oh, I have no family history of arthritis, if that makes a difference.
Thanks
Abby

To my knowledge there is no definitive test for Psoriatic Arthritis although it is one of the spondylarthropathies (group of spinal arthritides). I was diagnosed with Ankylosing Spondylitis some 12 years ago and a few years later started to develope some Psoriasis. I found out from my research and from my Rheumatologist that with the spondylarthropathies it is not uncommon if you have one you can easily develope another overlapping one. PS is usually diagnosed just from the symptoms and is generally treated as any other spondylarthropathy. I was recently put on Celebrex 200mg BID and it has not only helped my peripheral joint pain some by I noticed that my psoriasis has gotten better.
The only test I am aware of is the blood test for HLA-B27. Ask your Dr. about this test (it is quite expensive). If you are positive, it does not necessarily confirm PA but it means you are much more likely to develope it. Although if you are HLA-B27 negative you could also develope any of the spondylarthropathies. In other words, if you had no symptoms and were HLA-B27(+) you would not necessarily ever develope any of these diseases put your odds would be quite high of doing so. Conversely if you were HLA-B27(-) chances are great that you would never develope disease.
Do a search on all the spondylarthropathies and see if the symptoms of any seem familiar. Spine and back pain are definite symptoms as is the morning stiffness and periphral joint pain (with or without redness and swelling).
Hope this helps, good luck.

Al

 
Old 07-15-2004, 08:09 PM   #6
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Re: psoriatic arthritis

I was in my mid thirties when I was first diagnosed with psoriatic arthritis. I had ONE very swollen, (sausage-like) finger and one small (dime-sized raw patch at the base of my scalp). I had a negative RF and an elevated ANA.... On that alone a team of Rhuemies said psoriatic arthritis. I too had gel-joints in the morning when getting out of bed or when I had sat in a chair for a long period of time, to the extent that I felt like I was going to fall or was in a lot of pain. Since that time more joints have become involved including my back, toes and feet..... But, the presence of psoriasis definitely assisted in the diagnosis in the beginning. (Not all people with PA have the psoriasis part though).

Last edited by strbay; 07-15-2004 at 08:10 PM.

 
Old 07-16-2004, 09:55 AM   #7
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Re: psoriatic arthritis

Thanks, I am almost certain it is PA. I remember reading somewhere about having a small patch of psoriasis on your lower back(about hip area) and I do have a tiny patch of it there. Do you take anything for pain?

Abby

 
Old 07-16-2004, 03:08 PM   #8
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Re: psoriatic arthritis

If you are among those that have the psoriasis with the psoriatic arthritisit can appear anywhere or can range from a small spot to major involvement all over your body. I tried a lot of different NSAIDs in the beginning and it seemed that they would work for a few days and then the pain levels and inflammation would start to rise again. I had the best luck with Tolmetin, however the drug companies decided to take it off the market because it was a generic and there were newer (more expensive) drugs to try.

I started out with "Just ONE finger" and one little spot and I just felt I couldn't justify the DMARDs (disease modifying drugs). With each new joint that became involved I would think, "I can handle this if it's just these joints." Pretty soon I found it hard to basic things, such as those you mentioned. My kids felt badly when I was at their sporting events because I didn't clap my hands because it hurt too much. At the point where I was taking the maximum doses of NSAIDs on a daily basis I decided to change doctors and found someone that was an aggressive straight shooter,...but with a nice personality (I figured this is for the long haul). I occassionally have used prednisone stints when all esle failed and I really wanted to break out of the flare I was in. Then came the decision to start on Methrexate... which I really didn't feel was doing what I needed it to do. My rhuemy usually gives me choices of good, better and best drug/treatment plans. The side affects seem to increase with the rise in effectiveness. Seriously, if I had found this doctor sooner, I probably would have started the DMARD drugs sooner and avoided a lot of joint damage. PAIN... Drugs are only a small part of controlling pain. It doesn't hurt for me to help my husband lift something heavy....but the next day my joints ache and muscles spasm so badly. Avoid doing things that are known triggers for your flares.

Once you get a firm diagnosis, be willing to consider your different options based on effectiveness. I am thankful the PA didn't kick in until after I had my kids. Pregnancy and drugs usually don't mix too well... so ask lots of questions. On bad days, don't become a hermit... depression makes PA hurt more.

Hope this info helps.... please feel free to send me your questions.
Renee

 
Old 07-17-2004, 09:40 AM   #9
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Smile Re: psoriatic arthritis

Hi, I have PA and I have psoriasis on scalp, ears, around my eye, elbows, bottom of spine, and little spots around my body. I have had it for 7 yrs, and I have tried most of the steroid/prescription creams-solutions available and some work for a while, but then I grow tolerance to them. My dermatologist is having me take an anti-fungal pill for a month and said that there is research being done that shows there may be a link to the yeast in our scalp and the scalp psoriasis???? Has anyone heard of this?
I have had the arthritis part for 1 year. It started as parvovirus that I got from my 2 yr old and then I guess it triggered the PA. I have taken NSAID's most of which ruined my stomach, so I basically just live with the pain everyday. I finally got to the point where I could exercise again, but I tell you, even though it is supposed to be the right thing to do, I am in so much pain afterwards, it takes me a few days to get back in the gym again. Nights and mornings are by far the worst. I have pain in both hands(knuckles), elbows, back-mainly between the shoulder blades.. Hurts real bad to breath., pain in back of ankles, bottom of feet and occasionally stiff knees. Sometimes I wonder if it could be RA, it seems like symptoms of PA and RA are similar. Other than my knuckles being red and my pinky having a bump on the knuckle and my fingers being thick( my rings haven't fit for almost a year), I don't have any other lumps on my joints like RA can cause. If I bump into something or brush against something, my joints kill and if I barely bump into a corner or sharp object, then the area that I bump will usually swell up. I think of myself as pretty strong(physically at least prior to the PA).. I was able to give birth naturally twice with no pain medications. I did manually labor for work, and was fairly active growing up, so it was a huge hit to get PA and suddenly become almost bedridden. I try to do daily activities without showing people (husband)I am in pain, but sometimes I am so stiff that I can't help but walk like a mummy. Other times I just walk real slow. I don't want to complain to my family so I just keep it all inside. I try not to get depressed although there are days when I wonder how I got through this past year and I get sad thinking that I won't ever feel normal again. I want to try Enbrel because my Dermatologist said it is awsome, but it is so expensive and individual insurance has a Rx cap, so it isn't covered, and then if I changed insurance there is the pre-exsisiting conditions and all that. Has anyone been through this? I am hoping to talk to others that have had PA for at least a year to see if symptoms continue to worsen or if it ever goes into remission on it's own... I have not had one day of relief in a year, so I am a bit concerened. If anyone reads this and is willing to discuss their situation, let me know. Thanks! My name is Stacy and I live in Austin, TX.

 
Old 07-17-2004, 10:33 AM   #10
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Re: psoriatic arthritis

Hi Stacy,
Sorry things aren't going so well... you mention that you are seeing a dermatologist... do you also have a rheumotologist? Correct me if I'm wrong, but it sort of sounds like the doctors are treating your symtoms instead of trying to stop or slow down the disease. Have they tried you on any of the disease modifying drugs (DMARDs). I have not tried Enbrel for the same reason... my insurance doesn't cover injectables beyond insulin... and with regards to insurance... RA and PA appearing on a private health or personal life insurance application will get you declined almost immediately. (JOY)

You shouldn't have to live with 365 days of constant pain when there are approaches to this disease that can at least slow it down or suppress the symptoms. Has your doctor ever tried putting you on prednisone short term to try and break your cycle of inflammation? ... and again, has anyone prescibed any DMARDs? I've been on Methotrexate and Arava in combination and have no more problems with the psoriasis part and have mostly pain free days (short of over doing it no and then) The biggest hurdle to living and dealing with this disease is stopping the damage it does long term. Treating symptoms alone does not protect your joints pver the long haul.

Rereading your entry, I feel so badly that you are dealing with so much daily pain. During my first 2-3 years with PA I only used NSAIDs...I didn't want any part of the long list of possible side affects from the DMARDs. I was exhausted and in pain most of the time, and very bummed that life was passing me by. When I finally swtiched rhuemies, I told him I was willing to try anything that would allow me to have fun with my three boys and husband again. There are a lot of drugs out there that can be used or tried. He layed them out as good, better, best..... which also seemed to follow inversely as to the amountof possible side affects. However, for me it became quality of life. With careful monitoring (blood tests and doctor visits) you can minimize any complications that may arise from those drugs. I'm 43 now, and when I think back to how I felt, walked... I felt like I was 83. Can this disease go away or go into remission. I guess it can, however, I haven't heard of it happening to anyone that I know. My biggest regret in the 7-8 years that I have been dealing with this disease is that I wish I would have foresight to be more aggressive with my treatment from the very beginning.

Try to be realistic and optimistic... stress can really do a number on your body. You can't turn back the clock or make this go away. But you do have the hope for a better tomorrow. I always look out at the world and I'm thankful it's only PA that I'm dealing with (in light of all the other diseases that are out here.) Reach out and try to comfort or help others,... it often seems to lighten the load your feeling on your own shoulders.

I do believe that there are treatments out there that can reduce and control all the symptoms you are going through. ... and yes, 7 years later I do feel better now than I did during those first years... and I believe you can feel a lot better too! Hang in there and keep us posted! Renee

 
Old 07-17-2004, 11:58 AM   #11
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Re: psoriatic arthritis

Thank you! Yes, I have been informed of all the possible drugs I can take. My Rhuematologist wanted me to consider Metho or Enbrel, but since I can't afford Enbrel and I was trying to avoid the heavier meds, I opted for alternative medicine, but now I am considering other meds. I know I should try to enjoy my days with my kids. I guess once I come to terms with the fact that this won't just go away and after I have exhausted other treatments, I know I need to be proactive so that future deterioration won't occur or at least I should slow it down. How many mg of metho is safe yet helpful? How long before it starts working? Thank you!!

 
Old 07-18-2004, 11:24 PM   #12
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Re: psoriatic arthritis

Sorry you are going through such troubles. It concerns me to say the least. I have had psoriasis for 17 yrs now, its always been the worst on my scalp and ears. Over the past 10 yrs. little spots have shown up on my elbows, knees and lower back. I was about 17 when I first noticed stiffness and back pain and slowly it has progressed.
One thing I don't understand is, you said that you have pain/stiffness in the backs of your ankles. I have that too but my Dr told me it was Achilles tendonitis. So could it in fact be PA? About a yr ago I noticed the first bump(on my toe joint), which on occassion caused pain. I didn't know what it was, now I am starting to piece all of these things together. I don't seem to have the redness or swelling of joints, sometimes they are a bit stiff. I am concerned about how far this will progress. Does PA cause you to feel fatigued or weak? I have been having trouble with that this past yr and we can not find a reason.
I have never taken anything for the pain, and most of the time if I can get out of bed in the morning I will begin to feel better. I get so stiffened up when I sleep that I usually need help getting out of bed. Is that PA too. I also get pain in my upper back. Wow, I am amazed at how this all seems to fit together. Is PA something my GP would know about or should I see a rheum. for a diagnosis.

Sorry about so many questions, I am just trying to figure this all out. Thanks

Abby

 
Old 07-19-2004, 04:11 AM   #13
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Re: psoriatic arthritis

I, too, have PA. I have had the pain and stiffness since March 2004. The rheumy has pressed me all over, and to my astonishment has found it in just about every joint in my body. For me, it hurts intermittently in elbows, fingers, wrists, shoulders, back, knees and all the time in my hips. I HATE it! It seems to play with me, moving around my body. One part will be OK for a day or so, then it will attack me somewhere else. It seems unrelenting and cruel. I am on Arcoxia, which everyone seems to think is a wonder drug for arthritis, and it certainly has reduced some stiffness and some pain, but hell, I want to be pain free!!!! Just lately, I can have a week of feeling relatively good, then a week of tiredness, then a week of full on pain. Then back to the beginning again. I don't have obviously swollen joints, although the swelling that is evidently there, will push one finger tendon out so I can see it, white, right under my skin. It gives me the creeps. Depression certainly makes the pain worse, I've found that out. But it is a struggle to keep positive. I'm lucky I have children and a business to take my mind off it. But I hate that I have to drive everywhere, instead of walk, I hate that I can't stand very long, I hate that I can only go on a shopping trip to one store, or two if I'm lucky. I took ease of life completely for granted, and now that it has been taken away from me, I am angry and alternately sad at my loss.

 
Old 07-19-2004, 10:30 AM   #14
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Re: psoriatic arthritis

Yes I am tired constantly. I had achilles tendonitis when I was younger, but I think the pain in the feet and ankles now is associated with PA. I think anywhere you may have had injuries at one time, the PA will affect those areas as well. I was in a car accident 7 yrs ago, and now it feels like all those places that I had soft tissue injuries and now hurting again. Because PA is a clinical diagnosis, you definitely need to see a Rheumatologist or specialist. Your GP may have a hunch what it is but you should see someone else to get bloodwork/ x-rays and an evaluation just to rule out anything else. It seems like a lot of the autoimmune diseases resemble each other. My psoriasis is mainly on my scalp and inside the ears. I have little spots on my face around my eyes. Also on my elbows and spots on sternum, bottom of tailbone and belly button. My knees cleared up over a year ago and only one little spot has come back since. I am taking lots of supplements, as the NSAID's(I took Bextra, Mobic, Aleve,Vioxx )had really hurt my stomach. I am still contemplating taking the DMARD's and biologics are too expensive. It is impossible to go everyday without any pain med., so I have to take motrin once in a while, but I really just try to bear the pain if I can. I don't want to be dealing with ulcers or other issues as well. My dermatologist has me taking an anti-fungal pill for the scalp psoriasis for 1 month to see if it helps as well as using Clobex and tarsum shampoos. You apply to dry scalp then wash. I have tried numerous prescriptions and always end up having more scales and flakes. I try over the counter oils and shampoos, but haven't had any luck yet. DermaSmoothe scalp oil used to work, but I developed a tolerance to it as with everything else.
I have pain in my back-seems to be between shoulder blades or under ribs. When I take a deep breath I can feel it. It takes me several hours to get out of bed in the morning, but once I get up, I can move a little better, so I try to get moving as soon as I can, but the chronic fatigue gets me as well. I try to exercise on the stationary bike or elliptical machines. It hurts my feet and knees at times, but I am hoping it is worth it in the long run. I can't grasp very well, so it is hard to lift weights. I try walking, but that is the hardest for me. Going grocery shopping(which I used to love to do) is a huge struggle. Can't push the cart very well or turn it. I have 2 young girls(3&7), so trying to shop and take care of them is a real workout. I can't have them in the cart cause I can't push it, and I can't chase them around the store, so I am looking forward to my little one gettng a little older, just so I can enjoy getting out with them more. I have tried swimming and it still hurts my joints. I wonder if I am doing something wrong.
My prayers go out to everyone dealing with PA and anything else. I try to think positive and know it could be worse, but gosh, I can't believe so many people can live with this kind of pain every day. I try not to take anything for granted and I am just thankful for my sight. I know I can't just wish this away, but I do belive a little in mind over matter, so I hope that by staying positive and not getting too depressed I will feel a little better in time.

 
Old 07-19-2004, 07:12 PM   #15
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Re: psoriatic arthritis

I found this info about Psoriatic Arthritis... various forms of tendonitis are indeed part of the disease process.


Psoriatic Arthritis FACTS
Psoriatic arthritis is a specific type of arthritis. It causes inflammation in and around the joints, usually the wrists, knees, ankles, lower back and neck.

Psoriatic arthritis is a specific type of arthritis that has been diagnosed in approximately 23 percent of people who have psoriasis, according to the Psoriasis Foundationís 2001 Benchmark Survey.

It commonly affects the ends of the fingers and toes. It can also affect the spine. The disease can be difficult to diagnose, particularly in its milder forms and earlier stages. Early diagnosis, however, is important for preventing long-term damage to joints and tissue.

Most people with psoriatic arthritis also have psoriasis. Rarely, a person can have psoriatic arthritis without having psoriasis.

What are the symptoms?
*Stiffness, pain, swelling and tenderness of the joints and surrounding soft tissue.(tendons)
*Reduced range of motion
*Morning stiffness and tiredness
*Nail changes, including pitting (small indentations in the nail) or lifting of the nailófound in 80 percent of people with psoriatic arthritis
*Redness and pain of the eye, similar to conjunctivitis

How does it develop?
Psoriatic arthritis can develop at any time. On average, it appears about 10 years after the first signs of psoriasis. For most people it appears between the ages of 30 and 50. It affects men and women equally. In about one of seven people with psoriatic arthritis, arthritis symptoms occur before any skin lesions.

Like rheumatoid arthritis, psoriatic arthritis is thought to be caused by a malfunctioning immune system. Psoriatic arthritis is usually milder than rheumatoid arthritis, but some patients with psoriatic arthritis have as severe a disease as patients with rheumatoid arthritis.

Psoriatic arthritis can start slowly with mild symptoms, or it can develop quickly. It is very important to have as early and accurate a diagnosis as possible. Left untreated, psoriatic arthritis can be a progressively disabling disease. In fact, half of those with psoriatic arthritis already have bone loss by the time the disease is diagnosed.

How is it diagnosed?
There is no definitive test for psoriatic arthritis, but the following steps are usually involved:

*Person with psoriatic arthritis talks to physician
*Physician may refer person to rheumatologist, who specializes in arthritis
*Diagnosis is done by process of elimination using medical history, physical examination, blood tests to rule out other diseases and X-rays of the affected joints.


With regards to how much Methotrexate is safe or needed...That question is best answered by your doctor. I have taken both the tablet and the injectable form in varying doses for Mtx. I find the injectable has been more effective for me...however, mtx alone didn't control my PA ...I needed Mtx and Arava. My doctor tries to keep me on the lowest doses possible which means sometimes fluxuating the dose up when I need more control and lowering it when my white count gets a little too low. The other issue with both drugs has to do with how well your liver handles them. Even with Enbrel, my doctor said he would keep me on Mtx if I switch from Arava to Enbrel or even Remicade.

Last edited by strbay; 07-19-2004 at 07:15 PM. Reason: spelling error

 
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