I recently saw a Rheumy for the first time for all my daily aches and pains - mainly lower back and neck but also hips, knees and foot arches. I was expecting a physical exam and maybe xrays to be done, but was just told to get a barrage of blood tests done. From previous bloods I know my ESR is persistently mildly elevated.
I have a history of psoriasis 15 years ago that suddenly came on 2 weeks after tonsillitis. I ended up having a tonsillectomy due to chronic tonsillitis and my psoriasis completely cleared up after that. When the Rheumy heard this, he immediately started mentioning PsA and said it's a diagnosis made not by examining me but by looking at blood tests?? I am seeing him again next week for blood test results.
I'm after some general advice as to whether I should insist that he examine my joints or order some sort of xrays or scans. I don't want an incorrect diagnosis or to take unnecessary medication. The whole thing has me a little confused to be honest so any thoughts/advice would be appreciated.
Unfortunately there are no "blood test, MRIs, or X-ays to prove a Dx of PsA. They are almost ALWAYS negative. History and absence of other positive tests for other disease such as RA is how this disease is usually Dx'd. There may or may not be inflamation of the joints (usually there isn't real noticible amounts, enthesitis being more common) A negative ESR is more common than a postive one. PsA is a "seronegative arthritis" meaning (simply put) it doesn't give a "positive" blood test. Believe it or not the cheapest, and most dependable means of Dx is a short run of Predi..... (coupled with history etc)
If you wait until; you have positive scans, you are pretty much screwed as the damage is there (and won't go away). The idea of treatment is to avoid all of that. Sounds to me like you have a doc with a head screwed on straight. You have more to fear from untreated disease than "unnecessary drugs" If they make you feel netter you have gained, if after a while they don't. you move on nothing lost....
I understand treatment can be to avoid damage, but I'm wary of side effects, especially when I'm doubtful of the diagnosis. My aches and pains, to me, feel more like something you have when you have the flu and ache all over. If I had some other sign eg, nail pitting then I would be more confident.
Thanks for the input guys, and for putting up with newbies with questions like me :)
It takes according to some 8 - 10 YEARS of active inflammation to show up on a x-ray less for an MRI (but not a lot) Occasionally an MRI will show some active inflammation. Keep us posted about your appointment next week. That Neck back, hips, knees and foot arches and achy feeling sounds eerily familiar...... I suspect he well be bending and poking you before you really want to know it. The worst (for me) is standing still against a wall and measuring the distance between various parts of you body and the wall.....
There is also NOTHING wrong with a second, or even third and fourth opinion of you are uncomfortable.
Labs are always useful in helping diagnose PsA, mainly to prove that it isn’t something else entirely. The doc is looking for other causes of your symptoms, because psa cant be diagnosed with blood work. I wouldn’t worry too much about not having any X-rays done yet…that will come. Many docs do them to establish a baseline and to determine if and where there may be joint damage. I am a little concerned that the doctor didn’t lay a hand on you to do an examination. The only time I don’t receive a physical exam from a doc is when I go to the dentist. Everything else sounds right, but personally, it would concern me if a new doc didn’t do an exam.
When I was first diagnosed my general inflammation markers were elevated to include a mildly elevated white blood count. Labs were run to exclude other conditions. My rheumy did a physical exam & noted loss of hand strength & diminished range of motion in my wrists among other things. Xrays came later.
Now that I am under treatment, my rheumy tells me at each appointment how good the blood work looks. To be honest, these results seem to have little relationship with how well or how poorly I may be feeling. But my symptoms are better managed.
Raise all your concerns and questions with your rheumy. If you are not comfortable then seek other opinions as suggested by others. Bring your primary care physcian into the dialog.
Had my second rheumy visit today to get blood test results. They show ESR and CRP still mildly elevated and HLA-B27 positve; all other things negative. Asked if he would physically examine me, but he declined saying he rarely examines people but relies on the sensitive blood work.
Anyway, he said it was PsA (spondylo-arthrosis pattern) and mentioned enthesitis at tendon/bone junction.
He is ok with me gritting teeth and bearing it with Ibuprofen as needed, but i could also have Naprosyn SR.
Thanks for all who supplied thoughts and suggestions. There's a learning curve when anything new is diagnosed and much to be gained from learning from people who have much experience with it.