I don’t see any recent conversations regarding hypertension and PsA. When I was first diagnosed in 2019, my BP was typically 110/70 at rest. I have kept records and since then my BP has been climbing. In the last year I have struggled with pain and pressure around my eyes, including my eyes and sometimes my whole face hurts. NSAIDS don’t help much even though I was using Celebrex for number years….sometimes continuously or sporadically as needed. Because I don’t want another med, I’ve been in elevated BP denial. In the GP’s office it has been consistently around 170/110. At home in an ideal setting I can get it down to 148/97. So…I stopped fighting and am on day 4 of BP medication…and my head is clearer, headaches down to a 2/10 and feel better and BP was 127/80 yesterday. There are numerous articles that indicate that PsA can cause high BP…even apart from the pain factor. But my rheumy doesn’t agree. AND…now I find out that extended use of Tacrolimus (Protopic, Prograf) can cause elevated BP, which I have been using as needed (quite often) for psoriasis. And, Voltaren (diclofenac) can also elevate BP. So if I add it all up and consider the price of groceries…do I stand a chance? Comments/experience is welcome.
PsA is clinically known to raise BP due to the effects of persistent inflammation on it. I consider it’s indefensible to say it doesn’t. All autoimmune inflammatory conditions do this. So someone with Crohn’s or UC etc will similarly be affected.
I was one of those lucky ones that in my early 50’s before PsA struck me down suddenly too , I suffered low BP. I had been like that all my life. 18 months into PsA it was reading on the high side of normal. It rose higher and then actually caused me to feel unwell so off I went down the BP med route too. I’m on the lowest dose possible and my BP reads normal now.
And of course many meds also increase BP. And BP generally increases a little at least as we age. It is a given that most PsA patients will also suffer higher BP though.
That’s wonderful that you’re having such a good response @Amos
There is familial high blood pressure that develops in the '40s and '50s in my family. For the moment I’ve reversed it with a 70 lb weight loss, but it doesn’t mean that it’ll stay that way
But based on what you’re saying @Poo_therapy I’m now wondering if it’s really familial or if it’s from the shared autoimmune History.
Regardless, treating is appropriate and I’m glad to hear what a difference it’s made
Dang, Amos! I’m SO sorry your ‘ball-o-fun’ PsA has invited all its friends to the party. 
I’m with Poo, I can’t believe your dr doesn’t think it has anything to with PsA. Seriously? Any chance you can find another rheumy?
I’ve always had stupid low BP (as in put a mirror under her nose to check for breathing) until the last 5ish years. It still isn’t particularly high, just a touch on the high side of normal. It seems to have leveled off a bit since starting Humira. But I haven’t checked it lately so maybe I should do that.
If you tolerate the BP meds and can keep it under control with them then I’d call it a win. Especially if you can find a med that manages it with a low dose. But one thing I know for sure, it can’t go uncontrolled. I have a dear friend who had to have a kidney transplant in part due to uncontrolled high BP. Yikes!
You’ll be in my thoughts and prayers.
Rheumy’s are very hard to get replaced. Who I have is a good rheumy but very limited by time and patients. When one only gets 20 minutes (not 21) once every 4 months…only so much can be covered. When she walks in and asks how I am, it takes me ten minutes to rush through an adequate explanation. What is harder to find is a rheumy that specializes in PsA. I don’t know what the ratio is of RA to PsA patients but I would guess 3-4 times as many RA. But you are correct, I can’t let BP go unchecked. I’m not convinced about hoe effective my BP meds are…getting such mixed readings. Thanks for your support…it’s great to have so many using this forum.
One way to ensure your issues are heard is to send an email ahead of your appt detailing all the issues. Reading something is much faster for the consultant than having the patient detail things in person instead. And besides as a patient, you feel like you’re under immense pressure to remember everything and explain it cogently. It’s far easier to do that on a email which you can draft in your own time. I always email ahead of any appt detailing the good and the bad as much as I can and indeed listing my questions too so at the appt both I and my consultant hit the ground running so to speak. Obviously the consultant must read the email too before seeing you but it’s a decent way to aid cogent communication between you both.
BP meds take time to work often and even more often need tweaking too. For a lot of patients it takes a few months to get the balance right. So keep plodding on and hopefully your GP will get the balance right in time. There are at least 60 to 80 different BP meds so you have considerable options.
Thanks @Poo_therapy good ideas but my rheumatologist doesn’t do emails. On my first visit I had a typed, spaced one line at a time summary of my health history and she said she will examine me and look forward…handed the summary back to me. That wasn’t a good start but in Canada, many specialists are sort of treated as gods…if you get on their wrong side, your treatment can be affected. There are some good ones but they are good because their position is revered by the patient. When my psoriasis was acting up, I could have solved things with an email but the receptionist said, “she doesn’t do emails.” Likely a time and payment issue.
Gosh! So little leverage then to have any accountability from doctor to patient??? Being a lawyer myself I put a great store by having things in writing and having those things then put on my medical file too. It creates ‘the paper trail’ and so too the accountability notion.
In other words it lays the ground for any instance of professional negligence too. Not that I think for a moment my own rheumy is at all negligent - she could be if she didn’t read my emails though. It also saves shedloads of her time most of all and indeed mine too in reality.
It clarifies the all important medical history and chronology too. So it aids better medical outcomes because the actual medical history is acknowledged, thought about, analysed so in turn that churns out more thoughtful medical advice and treatment choices too. These are the basic tenets of appropriate medical care as obviously no patient presents precisely the same and often other medical issues interfere in the disease activity or progression so they require analysis too.
In your shoes I’d ignore the ‘she doesn’t do emails’ and simply do them anyway and then refer to their contents, pushing a more professional and ethical approach. But then I am maverick like that.
I can tell you I was seen by one of my rheumy’s colleagues as a normal way to share workloads and the experience was so dreadful I wrote a five page letter of complaint. It was very brutal. The next time he saw me in the waiting room he physically blanched. He missed an interaction (rare but known) between two meds I was on at the time which then caused me to spend 4 days in hospital.
After that escapade I have remained solely under my rheumy’s care thankfully. I never abuse this either, as in otherwise I am a patient patient, I ensure I do loads of research myself and only ask sensible questions. We remain having an excellent relationship build on trust and respect both ways. It means however that I trust her judgement and I know I can question it to understand it better too.
I really love the idea of sending an email ahead of time with primary concerns. I wonder if my last visit would have gone better with all of my concerns spelled out ahead of time. It certainly would have set the tone before my rheumy did. That is beyond unfortunate that an interaction was missed. There’s absolutely no excuse for that!
@Amos they probably already told you to look at trends with your blood pressure and not individual readings. I don’t know if they have you testing daily, but charting it on a graph may be helpful to see trends
Thanks @Stoney, I do keep a record of my BP but at bit randomly…at least once a week but now 4 times a week or more since on med for it. I don’t know what regulates BP but I suspect that something is causing swings and I can feel it in my whole body especially my head when it is higher. Kind of confusing to me. “Normal” today according to younger doctors is higher that what use to be. They don’t prescribe BP meds as quickly as they once did. For my age, (65) anything under 140/90 is considered a bit high normal. After 12 days on the med, if very still, seated and calm, I’ll get 138/87. Still much higher than it was. But that’s under the perfect conditions so when I’m doing yard work, bike riding etc, Its likely way higher. Beats me…But I like the reminder to look at trends also.
Big +1 to @Poo_therapy in regard to BP/heart meds.
My ticker goes a bit funny, makes up it’s own beat. The cardiologist gave me a few differing concoctions before we found what works best for me. It took months to get it right because I’d have to flush the previous drug, before trialling another. Now with the right meds, my ticker is fine, but if I miss a dose, a single dose, I can feel it.
Merl from the Modsupport Team
Here in the UK they can have you taking your BP daily, twice in the morning and twice in the evening and charting it for 2 weeks at least. They always want that second one as it tends to be a little lower now that you’ve done it once too. But that’s how we feed back BP charts and its on those type of trends seen over those two weeks any further BP meds decisions will be taken. Once a week doesn’t give you or your GP enough information as your BP rises and falls throughout a 24 hour period considerably. So they need to see some pattern of your daily readings.
Exactly that as in sending the email beforehand has you in the driving seat for the agenda of your meeting with your rheumy. So you’ve set the agenda and they know what your concerns are and it helps everything to have a more coherent focus. Often times many of us are actually quite ill when we see our rheumys and our emotions are running higher with tears often not far away. So doing that email helps keep things on track so much better.
Thanks @Poo_therapy, it’s a very good plan. Now I have to see if my rheumy even has an email that is given out. They like their control and probably don’t get paid to read emails but I’ll certainly try. AND if I’m in the driver’s seat, I’’ll take my blood pressure on the way to my next appointment while driving in traffic…(on the correct side of the road of course!) Thanks dior your practical advice!
Amos, I was scouting discussions on sudden high BP readings and possible explanations and came across your insight into rheumatologists here in Canada. Just had to laugh. So, what is it about no emails from patients and our friendly rheumatologists? I got the same answer from my rheumy front desk gate keeper. “She doesn’t do emails.” I wanted to do the same thing and send an update before the 3 months, 20-minute max appointment to save time. Nope, no can do apparently. I agree they probably aren’t paid for reading emails.
And try to get an earlier appointment than a scheduled one if something untoward happens. Good luck with that. Front desk keeper relays your message. Rheumy relays her answer back via the front desk again and back to patient. Gosh knows how the message gets screwed up getting relayed a grand total of 6 times. Like the kid’s birthday party game of “telephone”. Remember that one? She says you can message her anytime with concerns. Good luck with that one. I beat the system by having my GP or dermatologist intervene and insist I need to be seen by her.
I only graduated to every 3 months appointment, not 4 months, due to that botch-up of her missing the PsA diagnosis from RA that totally upended my life earlier this year. She realizes she missed obvious signs and symptoms. Other doctors’ reports were pretty blatant.
According to the specialist (rehab and physiatrist) I recently saw for cortisone injections in my sacroiliac joint and butt, PsA is often missed, misdiagnosed and generally misunderstood by many doctors including rheumatologists. I suppose I should cut my rheumy some slack. By the way, my rheumatologist was totally surprised I had seen, twice now, this specialist who heads the clinic at Ottawa General. Another doctor referred me. This is how so clearly out of touch she is with what’s going on and misses vital information.
Should I look for another rheumatologist? Of course I should. But these are hard to get in Ottawa and I’m lucky to have any, good or bad. Honestly, this one is more trouble than she’s worth. I’m now actively working around her rather than with her.
Even now, she dismisses clear symptoms of PsA and problems I’m having as probably not PsA but something else. She’s stuck on the fact that the age for these PsA symptoms is between 30-50, so I’m too old and it can’t be PsA but wear and tear or otherwise age related. I give up.
Just hugs on all that nonsense Janet and glad the other specialities intervene to get you earlier appts. It astonishes me as Canada was at least a leading expert on PsA too back in the day of Gladman’s very excellent research.
Poo-therapy, it is a lot of nonsense dealing with her. I’m wondering what the point of the exercise is any appointment with her.
Now, some input on sudden episode of high BP and swelling feet if you could, please. My BP, with medication, has been darn near perfect for the past 8 years. And my heart, last time I checked, was in good working order. I had a complete workup last year with all the fancy scans, everything hunky dory.
So, in early April, my ankles and feet inexplicably started to swell. By day’s end, I could barely walk on them for the spongy feeling and discomfort. I happened to have a scheduled appointment with my esteemed rheumatologist who, not surprisingly, dismissed this as edema that older people get. My two smaller toes on each foot looked particularly puffy and red, “sausage toes” typical of PsA. But, nope, she said they were not. I mentioned to her at this appointment that I was developing low back pain again, not too bad at the time. I don’t always have back pain. I’ve never had neck pain in my life, but I was also having this too, out of the blue some days. I mentioned from my reading that low back pain and neck pain can happen with PsA. She said mine was, no surprise, age related, not PsA as I am not the typical 30-50 year old when this starts. She did not take my BP.
I do have a mild case of venous insufficiency that comes and goes and causes a bit of swelling, but nothing like this. I took furosemide for a few months at one point which did nothing.
I went to my GP when the swelling started to extend up my legs. About this time, the low back pain morphed into the sacroiliac/sciatica delight that first hit me in January 2025 when everyone thought I had avascular necrosis and I was scanned to death. I had a similar episode this February. And now this. My BP at this appointment was around 150/90. I was totally surprised.
We agreed that I’d check my BP twice daily for 2 weeks and get back in touch. So now I’m dealing with high BP, swollen lower extremities and sacroiliac/sciatica pain that was gradually crippling me sitting, standing, and waking me up constantly so bad nights. I cannot take anti-inflammatories due to a severe aspirin allergy. I resorted to oxycocet I have on hand for occasional neuropathic facial pain and other neurological pain. I don’t take it very often as I don’t need to do so.
I was lucky enough to have an already scheduled appointment right then with the doctor I’ve seen before for the first episode of back/hip/leg pain when they thought it was avascular necrosis. Lucky coincidence. She deduced it was indeed a rather out-of-control SI joint episode on the left side extending right into my foot. When I told her my diagnosis had changed from RA to PsA, she acknowledged that this pain was typical of PsA and age did not factor into it. Three ultrasound guided cortisone injections later into the worst spots, and I was on my way.
Within 5 days, pain totally gone, swelling gone and we’re off on a 5-hour car drive to spend a week with family. BP returned to my usual normal. It’s been 3 weeks now and all is still well. BP back to normal.
So, my question is, any idea what caused this uproar in the first place? High BP pain related, PsA related? Is the back pain I’m getting PsA or not? And what’s with the swelling feet and ankles that started everything off? I’m at a total loss.
PsA inflammation can cause higher BP for sure. I spent my life having almost low BP. Post PsA I’m now medicated for high BP. Your rheumy completely missed the entire connection. SI joint inflammation is a rather nasty part of PsA inflammation as it ends up affecting so much of you. And we hold our bodies differently when in so much pain which of course causes more issues to develop.
PsA truly doesn’t care what age you are. Babies can get it. I know one person quite well who had it since she was 18 months old. She’s now nearly 50 years old.
PsA affects at least 68 joints, plus the entire spine and every tendon and ligament you have. The extent of PsA inflammation can go on (like in RA, which only affect 28 joints and not the spine) to affect internal organs to include our heart and lungs, kidneys, liver, pancreas, bladder etc etc. So it’s an entire whole body systemic disease.
Interestingly I’m now being investigated for cardiac problems given I developed swollen ankles which weren’t PsA induced plus shortness of breath. There is heart disease in my mother’s family plus I’m 64, overweight, a life long asthma sufferer and believe it or not used to be smoker. Yes I was incredibly stupid on that one. We know from a blood test my heart is moderately stressed and my echocardiogram is in a week’s time. Could this also be PsA induced, yes of course it could be. My view presently is that cardiac issues tend to be more fixable than COPD or lung cancer. So we’ll see what happens.
Not every NSAID has any aspirin though, has your GP thought of Celebrex or Arcoxia/Etoricoxib? I take Etoricoixb, and once I don’t go too often above 60mg it doesn’t affect my lung function. I couldn’t function without it given PsA issues.
As my rheumatologist is the one who finally confirmed my suspicion of PsA, plus my GP and dermatologist diagnosis of PsA, it irritates me no end that she negates every symptom of PsA I draw to her attention.
It’s the low back pain aspect of PsA she claims is not PsA but wear and tear in my case. She has, however, never actually examined my low back or sacroiliac joint. Nor has she taken a history of any low back episodes or treatment I’ve had for it. It did in fact first show up many times between the ages of 30 - 50, if she would only ask. And I’ve run out of patience with her. I’ll focus on what the doctor at the sports med/rehab clinic says.
I’m thinking that pain and inflammation from the sacroiliac joint was a big factor in causing that BP spike. Those cortisone shots basically eliminated the pain. BP is just fine now. How the swelling feet and ankles is involved in all this, don’t know.
The aspirin thing is related to a severe reaction 30 years ago to a sachet of powdered aspirin I was given when I was in hospital in Geneva. Within minutes, I was covered head to toe in a prickly, bright red rash. Very colourful. It has spooked every doctor I’ve had since then. They simply will not prescribe NSAID meds. We did try Celebrex and another one in same class ,but both eventually provoked my IBS beyond what I wanted to deal with daily.
Prednisone I’ve been on in short courses for severe inflammation when absolutely necessary, but my glaucoma does not appreciate it. It increases pressure in the eyes. I’ve already lost sight in one eye despite every possible intervention. I’d like to keep vision in the other. And prednisone has other side effects I just don’t need.
Question about hydroxychloroquine. My first rheumatologist started me on this in 2010. I’ve taken it consistently without any problems since then. However, my rheumatologist immediately stopped this the moment she confirmed the diagnosis of PsA in December. She said it can provoke psoriasis initially or cause existing psoriasis to flare. Is this accurate? I have noticed increased joint pain since I stopped taking it. And 2 episodes of sacroiliitis since December.
Yes this time your rheumy is right, hydroxy is no longer permitted to be given to PsA patients because of the psoriasis risk but also the eye risk - given you’ve lost the sight in one eye this would be really important too. Have you ever tried sulfasalazine? It might be a suitable cDMARD for you instead of hydroxy.