Signs of PA

Skin, nail and hair health
1

Is it possible to have PA with no swelling of the effected joints? I have met physiotherapists and consultants whose general rule is, if no inflammation in the blood and swelling of the joints, then no PA. What have others experience, for you can have joint pain without swelling.

Also with psoriasis and in particular nail psoriasis, if the key to preventing joint damage in PA is early intervention, why arent DMARDs issued when the skin and nails issue present? Or is it possible to prevent further damage quite quickly?

2

When my PsA first started I didn't have a whole lot of swelling or inflammation.  Even now when I get a bad flare my joints swell terribly and the pain is unbearable at times.  It seems to be worse in my hands, feet and neck lately but I do have it just about everywhere.  Even had a lung biopsy a few years ago and they found nodules (thank God not malignant) that they said were from the PsA.

I do not have Psoriasis, however my Dad was covered with it so I guess I inherited this immune system problem.   The weather really affects me and currently I am on prednisone again for a flare.  I also take Humira injections bi-weekly.

3

Yes it is  possible!  you need to see a rheumatologist  for  proper testing  and  diagnosis!  Early  intervention is the key!!  I have had psoriasis since i was 20

at  age  approx  46  diagnosed with psoriatic arthritis!  had symptoms for few years before that  wasnt sure what was going on  ! Rheumatologist  did alot of  testing!! im now 59!  its a battle!!   early  on i went on  medication for psoriasis  and nails issues!!

 

4

Thanks for the advice, i am pushing for a 2nd opinion, as my first rheumatologist doesnt see the need for DMARDs if their is nothing in my blood or visbile joint swelling.

You mention early on you went on medication for psoriasis and nail issues was this MTX? Was this before the joint issues? The reason i ask is that i know MTX seems to be the go to drug for skin and nails, as well as joints, so i am wondering what your experience of this medicine was like?

5

I've been watching the discussion as I strongly suspect that I have PA. Originally diagnosed as osteoarthritis I quickly developed nail and skin psoriasis and was treated with Methotrexate. This almost completely cleared the nail psoriasis and so I've been on a reducing doseage for the last year (from 20mg down to 10mg).

The last reduction seems to coincide with a significant increase in joint pain and pain from knuckles and ankle raher than just knees (the original issue).

I'm due to see the psoriasis consultant in a couple of weeks and plan to take it up with her as my GP doesn't seem to have a clue!

Methotrexate: positive outcome with the only negative being VERY sun sensitive - I have to avoid sun or cover up. 30 minutes in UK sun will cause 2nd degree burns!

6

Of course you can have PsA without inflammation........like all autoimmune diseases, flares come and go, so it's possible to have it without inflammation at the current time.

In answer to someone's question about MTX: it is standard first line treatment for PsA and also Rheumatoid Arthritis, as it is a DMARD. DMARDS, like biologics, help to halt to process of the disease.

7

Hi   yes i went on methotrexate years ago  for severe psoriasis plus tar compound  ointment  and ultra violet light treatments!  battled psoriasis for years!      used metho trexate  when they were extreme!! years later  the joint pain  and  joint  destruction  started  id  say few years before  they actually  diagnosed me with P/A  IN  2001!     i have been on methotreaxte since then  2.5 mg  x6 pills  once  a week   with folic  acid

I have always been  nauseated with this  drug  yuk!! but i have tried to go off a few times  and the flare ups  are over the top!   so i  suck it up  for 2 days i feel yucky   !  also have regular  blood testing  when on this  drug!!

8

also forgot to mention  a couple times a year when im  real  bad  i go on prednisone! 

9

PsA does not show up as a positive on most blood tests its more about the signs and symptoms rather than the actuall tests. I'm having a hard time with mine. I hope you get some treatment soon. 

10

thank you for comments, and i hope that the increase in MTX provides you with joint relief, from your information it looks as if this treatment is potentially very succeesful for you. Do keep pushing as many sources do indicate early intervention is the key. It would be great to hear how you get on. 

I note the work of Dr. Helliwell and others on the success of MTX in achieving remission, which is the best case scenerio with no cure. This is encouraging, but for me, the confusion with this treatment is the fact that the main US charities believe the biologics are the only way to halt PA, as well as RA, in 95% of cases. Please see the Dr. Q&A on the national psorasis foundation for this information.

http://services.psoriasis.org/drtellme/index.php/psoriatic-arthritis/long-term-effects-and-progression-of-psoriatic-arthritis

For me i have had several blood tests, some the same day as "flare"', and still no inflammation in the blood detected. From what i have read its really ultrasound and MRI that gives early insight. X-rays are either before or after shots in my opinion, so not really the best tool in the toolbox for staying ahead of this disease.

My hope is that with a DMARD, traditional or biologic, i can treat PA in similar fashion to say diabetes or asthma, no cure but it can be kept in its place by taking your medicine, you can then just get on with life. If left to run rampant it will get worse, but with early aggressive treatment, damage can be prevented.

 

11

Have you had experience of DMARDs? If so, it would be interesting to know your experience. I wonder what the prospects of long term remission are, when you look at the high profile case of Phil Mickelson, there was a guy who couldnt get out of bed, but today is in the UK competing in golf. Clearly Enbrel has done very well for him, i wonder what the long term outlook is i.e. can someone take such a medicine for 20-30yrs?!

12

David,

I was diagnosed with PsA about 22 years ago here in the US. Later I would also be diagnosed with sero-negative Rheumatoid Arthritis and Ankylosing Spondylitis.

The standard first line treatment back then was  Methotrexate [DMARD]. They started me at 5 mg [pills] and graduated the dose over the next month until I was on 10 mg. Over the years the dose was increased gradually. It halted the progress of the disease.

Back in the early days we didn't know about taking folic acid, but that was added eventually. 

By year 15 on MTX it seemed to not be as effective. I was at the 25mg dose, which is typically as high as they'll go.  The body builds up a tolerance over time to drugs so the effectiveness goes down.

By this time biologics had been out for a number of years, but due to other medical issues, biologics like Enbrel and Humira were contraindicated for me. 

I struggled with increasing joint pain and inflammation and turned to getting Kenalog [steroid] injections in the joints, which was a lifesaver for me. But still, it never really eradicated all the pain and inflammation.

I should mention that I never took systemic Prednisone pills. I did, and still do, take NSAIDS; I'm a huge fan of Celebrex. Over the counter pills like Tylenol, Aleve, Ibuprofen are a waste of money in this disease.

Finally, three years ago, I decided to gamble and try the Humira. It was a gamechanger. I feel better now than I have in over 20 years.

I'm a member of other RA and PsA forums and many people who go on the biologics have the same experience I do - excellent quality of life comes back.

Then there are those who can't seem to catch a break and rotate drugs just to find the right one.

I want to bring home one point:  so many people do so well on biologics and even DMARDS such as Methotrexate that they don't bother posting on forums. So what you see are forums filled with members who are desperating seeking relief, which pretty much gives the impression that ALL people with the disease are doomed [because the successful patients are nowhere to be found on these forums].

I make it a point to post my successes with the drugs here so that people newly diagnosed can see that the drugs DO WORK in the vast majority of people.

I have to tell you that since I started the drugs over 20 years ago, I've had no further joint damage. The drugs are responsible for that.

No one knows yet what the very long term effects are, since the biologics have only been out about 10+ years. I have heard of people who enjoyed great success on a biologic for several years and then it stopped working. Most of those people switch to another biologic and most have success repeated. But at this point I don't know that anyone can say with accuracy exactly what the very long term remission probability is.