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09/25/2011 09:32 PM

Psoriatic Arthritis... without the Psoriasis

paperbagprin
paperbagprinPosts: 102
Member

I know this might be a weird question, but today the rheumatologist (I had to see a different one just for this appointment) said he thought I have Psoriatic Arthritis.. I'm very confused because I don't have Psoriasis.

I'm 21 years old. A bone scan showed inflammation in my knees, hips, shoulders, wrists and finger joints. I also have Raynaud's, dry eyes, nose ulcers, dry mouth, fatigue, flu like symptoms and a vasulitic rash (Petechiae). My blood tests show not a lot. A weak ANA and the last one showed an abnormal liver function (which is being monitored). My schirmer test was normal but ophthalmologist confirmed dry eyes. I don't drink alcohol and I don't smoke.

My usual rheumatologist was looking down the lines of Sjogren's or Lupus. This rheumatologist took me right out of left field with this Psoriatic Arthritis.. His reasoning, my hips are involved (spine is fine), I have a bit of pitting in my nails and on my bone scan it showed inflammation in the DIP joints (the end ones) and MCP (ones at the base of my hand).. My PIP (middle) are the ones that hurt!

But I don't have Psoriasis and no one in my family does either...

Does anyone thing this is just slightly strange? He was a strange doctor too lol.

Thanks.

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09/26/2011 06:34 AM
DonnaEvans77
DonnaEvans77  
Posts: 3031
Senior Member

No such thing as a weird question. That's a good question. Hopefully somebody here can help you out with this one. You might want to get a second opinion on that, that's what I'd do. I'd be confused too. Maybe you can have it without the rash. Sure hope you get answers. Please keep us posted. Hugs, Donna

09/26/2011 04:32 PM
paperbagprin
paperbagprinPosts: 102
Member

Thanks Donna, I'm just so confused by this all! I'm going to see my regular rheumatologist from now and she's the one who thought Lupus or Sjogren's not this weird diagnosis! So hopefully she'll explain and it'll all make sense. Thanks.

09/27/2011 09:20 AM
hatbox121
hatbox121  
Posts: 11022
VIP Member

My daughter was also looked at for PsA because of nail pitting which is common is psorasis. Sometimes the arthritis shows up many years after only one episode of psorasis. It shows up in the hair(scalp) so sometimes it is missed. Other times, not as often, the PsA shows up before the psorasis. I'll look for some links that I was researching when it was brought up for my daughter.

09/27/2011 09:26 AM
hatbox121
hatbox121  
Posts: 11022
VIP Member

http://www.mdjunction.com/arthritis/articles/what-is- psoriatic-arthritis

http://www.arthritis.org/disease-center.php?disease_id=21

http://www.emedicinehealth.com/psoriatic_arthritis/ article_em.htm

From above link- People with psoriatic arthritis might not have obvious skin findings, or they might have minimal scaly red skin on the scalp, in the bellybutton, or between the buttocks. Some people with psoriatic arthritis might just have nail abnormalities and arthritis and no other skin symptoms.

You may experience various nail changes (see Nail Psoriasis). Your nails may loosen (onycholysis). You may notice lines going across the nails (side to side rather than root to tip) or yellow spots in the nails. You may also notice little pits in your nails. The more pits you have in your nails, the more likely you are to have psoriasis. Usually, if skin and arthritis symptoms begin at the same time, nail findings begin too. Often, if you have symptoms in the joints at the ends of your fingers or toes, then those nails will be affected. Eighty percent of people with psoriatic arthritis have nail abnormalities.


09/28/2011 12:52 AM
paperbagprin
paperbagprinPosts: 102
Member

Thanks Hatbox, he checked my scalp and said it was fine. I don't think I have extensive pitting. I've had doctors look for it before and have said that I didn't have any. I spoke to my GP today and she admitted this wasn't her area of expertise but that it 'helps' if you do have the Psoriasis or at least a family history but you don't need it. I just feel like it doesn't fit.. From all the research I did I said 'well I can definitely rule Psoriatic Arthritis out'.

Thanks for the links. I'll check them out!


09/28/2011 06:10 AM
hatbox121
hatbox121  
Posts: 11022
VIP Member

Just a side note here, you can have one small patch and the PsA show up 20 years later. So it's kinda weird. On another note, the treatment of PsA is generally the same as rheumatoid arthritis, etc. Usually a DMARD is used. The most common injectable is methotrexate and that is used in pill form for lupus as well. So despite the difference of names, the same meds are used to treat them for the most part. Of course there are different meds that treat symptomology. But since all of those lupus, RA, CTD, PsA, etc are autoimmune the main treatment is to suppress the immune system. That is accomplished by using a DMARD or TNF alpha inhibitor. My daughter who was/is looked at for the PsA, but is currently dxed with juvenile idiopathic arthritis is on the MTX and was on Enbrel which treats both the PsA as well as JIA plus others.

09/28/2011 08:11 PM
paperbagprin
paperbagprinPosts: 102
Member

Thanks Hatbox. That is kind of weird. I don't recall ever having any skin problems except this petechiae. I think the reason why I'm being told this is because my bone scan showed inflammation in the further finger joints which is apparently uncharacteristic of RA. My liver test was up the last two months, so I think that may have been why I'm not on methotrexate and possibly they hope that Plaquenil will do the trick. I guess I just wish I had a bit more clarity. The biologic drugs are pretty difficult to get where I live and I don't think I would ever qualify.

Thanks.


10/01/2011 02:40 PM
hatbox121
hatbox121  
Posts: 11022
VIP Member

Ah, well Plaquenil is used for RA, lupus and PsA so whichever it is should help. Any idea why the liver values are up? They test my daughters every three months and hers was up once on only a couple of the individual tests. The nurse said that one of them being up(I can't recall which one) signaled that she had some inflammation going on.

As for the biologics, I'm sorry that you don't even have that option. As bad as some people cry about our health system in the US, I dread going into this universal health system like Canada or England for this reason. I have the option now to either get it or not based on the choices that her dr and I make together without all of the politics involved. Sure I pay for it, but it's worth it to me.

Post edited by: hatbox121, at: 10/01/2011 02:42 PM


10/01/2011 02:52 PM
paperbagprin
paperbagprinPosts: 102
Member

I'm hoping the Plaquenil is going to help. I've only been on it a week tomorrow, so far too early to tell. No idea what's up with my liver. The doctors don't see too concerned, they're just monitoring it. The arthritis nurse in my area said that some time people's liver function is slightly higher than the norm and they are probably just monitoring what a normal level for me is.. But I've had my liver test done every month for the past 6 months and the first 4 were normal, last two weren't. Hopefully they come down or work out what's going on. It's ironic, because I don't drink alcohol, in the last two months I've only been on Celebrex.. I'm a student and I have friends who get drunk 4 nights a week!

I've heard the biologics can give you your life back. It does suck that it's not an option for me. I think both systems have pros and cons, but it's things like this that make me dislike our system!

Thanks =]

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