After some advice please!

Hi. I don’t know if this is the place that I should be, but I’d be really grateful for some advice!

When I was a child I was diagnosed with guttate psoriasis. Since then, my psoriasis has been very mild and confined to my elbows and knuckles (just plaque psoriasis I think)

Anyway, over the past few years, I’ve been suffering with increasing joint pain and fatigue and have been diagnosed with fibromyalgia. I didn’t think anything of this until the last couple of weeks where my pain has increased, particularly in my fingers, wrists and elbows, and I have developed what I assume to be psoriasis on my inner lower arms (just feels like rough skin with a couple of raised red patches but after a shower gets very red and is in patches, looking more like when I had the guttate psoriasis) and a friend suggested that maybe psoriatic arthritis might be the culprit.

Does any of what I’ve said sound like I may be on the right tracks? What other things should I be looking out for? Thanks for any advice that anyone is able to give!

1 Like

Hi Picklepudding!

The main thing that strikes me is that a person who has (or has had) psoriasis who presents with joint issues is waving a lot of red flags for PsA. For example, according to NICE guidelines, dermatologists should refer any patients with joint pain, swelling etc. to rheumatology to be assessed for PsA. So if this possibility has not at least been considered by the doctors you have seen then it may be that you’ve encountered some of those who for some mystifying reason are blind to the disease. I reckon they are getting rarer but I think they still exist!

If you were to pursue your suspicions with your current rheumatologist (assuming that is who diagnosed fibromyalgia), or ask to be referred to a different one for a second opinion, then you’d have UK guidelines on your side. One of the key things to look for is any changes to your nails. A higher percentage of people with PsA have psoriatic nails than have current psoriasis. And the look of psoriatic nails can vary considerably. If you have any swelling at all then that is significant as is fatigue. And have you had a blood test? While some folk with PsA do not show raised inflammatory markers (ESR or CRP), some certainly do and of course that would add to the likelihood of inflammatory arthritis.

But the main advice is to be ready for battle. Again and again and again (sadly) people have to push hard to either get a diagnosis of PsA or to exclude that possibility to their own satisfaction. Mind you, sometimes the first door we knock on opens and it’s all sorted! You can go back to your GP and ask to see your rheumy again or to see another one, that is very much your right.

Oh, and you are in the right place! Welcome!

Hi and thank you for your reply and welcome!

Well I don’t have any problems with my nails so does that exclude it as a possibility? I haven’t seen the rheumy since my fibro diagnosis 4 years ago as I was discharged back to the GP.

I’m currently seeing 2 different orthopaedic surgeons for problems and pain in my ankle and my hip. My fingers are extremely stiff and painful as are my wrists and elbows…in fact every joint is painful but they are the ones I notice the most. Looks like yet another doctors visit is on the cards!

This is my arm after having a shower…

Arm looks sore! You could ask your GP for a referral both to a rheumatologist and to a dermatologist. Ask the Orthopaedic surgeon too, they might refer you across, that’s what mine did. On the face of it your concerns sound reasonable so if you ask basically everyone for a referral surely one of them would cooperate. To my mind the simple statement: ‘as I have psoriasis I want to investigate whether I could have psoriatic arthritis’ should do it.
The nail statistic is about 80% of people with PsA showing changes to nails. That still leaves plenty who won’t have this sign.
Stick with us, it’s not fun for you but there are quite a few of us here who enjoy (if that’s the right word) supporting people who are navigating health systems to check out whether they have PsA. Seems to me that most people do get answers in the end.

Thank you so much…I’ll keep you posted!

1 Like

Hi Picklepudding (love your name)
Ugh and OMG. A doctor suggested to me years ago that maybe it was fibro. Some PsA symptoms mimic fibro and vice versa. Your arm does look sore and I see a little round thingy on the side that looks like how my psoriasis looks in some spots–you’d almost think it was ringworm, but it’s psoriasis. But all the joint pain, sore fingers, wrists, elbows–my PsA came on gradually like yours but it wasn’t long before I was diagnosed. At the time I was told I was lucky to have slow progression of the disease–it hits some people like a rock and they go downhill fast. One thing it seems you’re saying the pain is “snowballing”–and that’s what happened to me. I dealt with it for several years as it was building up. My rheumy was patient with me not wanting to go on any meds but kept encouraging me to because he said the damage was happening. When it got really unbearable I found this group and they helped convince me that meds were necessary unless I wanted to be extremely crippled a few years down the road. The sooner your doctors figure this out and get you on the meds that work, the better–Enbrel works for me–even though I have some damage to my back and feet mostly–it has helped me feel a LOT better. Keep pushing for answers!

Thank you. The round bit on the side is there and visible, the rest of it is mostly just showing after a hot shower…the rest of the time I can feel it but it doesn’t show much. But the psoriasis on my elbows is really good at the moment. I’ll definitely make an appointment as at the moment every ache and pain I have is blamed on the fibro. I just want to know for my own peace of mind that it’s not something more serious!

1 Like

We like you already, Picklepudding. Anybody who chooses a screen name like yours must be OK. :wink: We’re glad that you found us, but so sorry that you are experiencing what sounds only too familiar to a lot of us.

I really can’t add a lot to what’s been said, but I have strong feelings about diagnoses of fibromyalgia. It is a real disease, and a miserable one at that, but when it is the first diagnosis that gets put on the table, I’m pretty cynical. It is all too easy for docs to say “You’ve got fibro …” and once that thought is in their minds, all other symptoms are attributed to that. No, fibro, in my book, should be a diagnosis only when every other possibility has been excluded. You have many signs and symptoms that fit very neatly into the PsA box.

I cannot tell you how many people have come through here in a similar position to yours. We’re not doctors, but we do have far more collective experience with this disease than most medical practitioners, including rheumatologists. Your responsibility (to yourself) is now to get a diagnosis that “feels” correct to you. Whether it is PsA or Fibro or whatever, when you walk out of that office, you have to be able to say to yourself, “OK, that explains what I’m experiencing and it makes sense to me.” Clearly, fibro alone no longer makes sense. So gird up for battle, as Sybil says: until you walk out of the consult feeling that it all now makes sense, you need to persist until it does.

Both psoriasis and psoriatic arthritis can be a challenge to diagnose, but I think in your case there’s going to be enough evidence to “nail” at least one of the two. Here is a great UK site which you will probably find helpful. Take a really good look at this page.

Nobody wants a diagnosis of PsA. But if that is what you have, you need to know it, and you need a skilled rheumatologist to treat it as aggressively as possible. Worse than a diagnosis of PsA is undiagnosed PsA: now there is something to be really scared of. Sometimes people have PsA that is barely more than a mild nuisance. But PsA can also be aggressive and highly destructive, and it can trash joints faster than you want to know. Joint damage is a one way street, and one that is painful to walk.

You have come to the right place: we love supporting people in their quest for a diagnosis. It’s not so much that we like being “right” (OK, we like that too …) but when we have cheered someone on in the quest, when we have offered experience and strategies for getting a solid diagnosis, we know that we have probably helped another human avoid significant pain, suffering, loss and costs. And that is very satisfying.

Look around here and don’t be embarrassed to ask questions. Hang in there, and hang out here!

All the best to you, Picklepudding

PS If you hold your fingernails up to a bright light and look closely at the surface of your nails, is the surface of the nail perfectly smooth? Just wondering.

Thank you so much for the advice. Some of my nails are slightly ridged…even through my nail varnish I can see that but not sure if ridges are relevant? I’ll have a look at the website, thank you. I like to arm myself with as much information as I can before I go to the doctor about anything!

Also, the top joint of my index finger (which is the most painful one) is much larger than the others…

Ridges on nail (are ridges relevant?)

I think you have the most glamourous nails ever displayed here! However I’d consider the ridges relevant and would definitely show them to a rheumy or derm for their opinion. Minus the varnish though, 'cos presumably they look rather more ridged without it.

If the finger joint feels very solid it could be osteoarthritis but again that’s a call for a rheumy to make (and even if it is OA, that in no way precludes having PsA as well).

That finger joint is one which PsA routinely attacks, but like Sybil says, a rheum needs to examine it (which s/he will when they check all the joints of the hand).

Yes, the ridges might be relevant, but more relevant would be tiny pinprick dents in your nails. How are your toes? Any fungus-y nails, or ones that lift and break off?

Another question: do you ever have aches outside the joint, like backs of the knees or lower calves? Lower back pain? Carpal tunnel?

Don’t you think this is interesting? Or are we being just too nosey?

Happy New Year to you, Picklepudding!

No pinpricks or anything similar. I get pain pretty much everywhere!

Happy New Year to you too! x

Hi again, Picklepudding,
I know you don’t want a more serious diagnosis than fibro (I don’t know how serious fibro is compared to PsA, but I’m thinking PsA is worse) but at any rate, you need a correct diagnosis. As depressing as that is if it’s PsA, it will get you on the right track to feeling better sooner. We all hate having PsA, but I think most of us are hopeful and coping fairly well with the meds available to us. I can’t say I’m not disappointed that I have PsA and neither of my parents or any of my siblings have it–as far as I know none of my extended family have it (I have 70+ first cousins altogether)!!! I’m the “lucky” ONE! I’m jealous of my parents–my mom is almost 92 and enjoyed really phenomenal health most of her life. My feet are bad–I can barely walk sometimes and long, leisurely strolls are out of the question–forever–and my back waxes and wanes. My mom’s feet have never given her any trouble and they look like the feet of a much younger person–she has no swelling in her ankles. It makes me feel inadequate and sad because I know I won’t go into my 70s and definitely not 90s in such good shape, no matter what I do. I know I should only be happy for her–she is a tough woman and has had heartache with the loss of two children and my dad and 6 of her younger brothers, several sister-in-laws and most of her friends are all dead, and she has had a few health issues along the way, but nothing as debilitating as PsA can be. It sucks being the wimpy one in the family and I try my darndest to push past the symptoms and lead a busy and productive life. I just want to tell you that we here know what you’re going through and we want the best health for you. I’m less affected by PsA than a lot of people with it, and it’s best you get treatment so you can avoid it taking over entirely and making everyday living more difficult than it already is. Good luck to you!

1 Like

So the psoriasis cleared up. But today I have suddenly got an incredibly painful finger joint…top joint in ring finger. Doesn’t hurt too much if I keep it still but if I press the joint I literally hit the roof. No redness or swelling (although I’ve had to remove my rings and they were a struggle to get off which isn’t normally the case). No idea if I’ve injured it but I can’t remember doing anything. Any ideas?

My suggestion is that a doctor (pref a rheumie) needs to look at that. Sounds like an inflamed joint, but I’m no doc.

1 Like

Yup yup, seconding getting into the Rheum on that one from @Seenie. While it could just be an injury that may heal on it’s own, how many “mystery” pains do we have that generally can’t be traced back to the ever present passenger we’ve got?