Early symptoms of PsA?

Hello to all,
I have had psoriasis for over 20 years. Started on my knee then suddenly disappeared. Came back on my forearm where it has been for 20 years. Now it has spread to my elbows and inside my ears. I will be 51 this summer. So I recently began having pain in my right heel. When I get up in the morning, I can barely walk because of the pain and stiffness. My left heel has decided to get in on the action so now my first steps are comical to watch. The pain is at the back of my heels, feels like the tendons are tight and painful. I don’t have nail pitting or thickness and I have never experienced sausage type swelling in my fingers or toes. I do have pain in the joints of my hands, sometimes I can barely get my right thumb to move. No swelling, just joint pain. Anyone else with PsA experience early symptoms with heel pain? I haven’t been DX yet, but my Dr did mention it on my last visit after I made the aforementioned complaints.

Hi Timothy and welcome! I’m glad you posted your question. So this is not something that I have personal experience with. What you’re describing is likely enthesitis, or insertion point inflammation. It’s very common, and the Achilles is a common location for this.

What you’re describing also, pain and stiffness in the morning, that takes a while to get moving is pretty common. My husband has mild PsA, but his primary pain area is his lower back. So far he’s been just taking a daily NSAID, but I’ve been encouraging him to talk with the doctor about being a bit more aggressive.

Where does that leave you? Yes, please see a rheumatologist. Also consider getting a referral for PT once things open up again. In the meantime you may want to try ice and /or heat, and gentle (seriously gentle) stretching.

We definitely have others here with experiences similar to what you describe. I would expect some more responses soon.

Thank you for your reply, I will definitely be seeing a Rheumatologist soon.

Hi @Timothy88,
Those types of symtoms and how they’re affecting you first thing in the morning is very like PsA indeed but you do need a rheumy to truly investigate and tell you that.

I can get heel pain alot. Try freezing small bottles of water and when frozen roll your feet on them sitting down and get the cold bit right in the sorest places. It’s good to wear socks doing this to protect the skin on your heels.

Another thing to try and hot/cold. So use those ice bottles for 5 minutes and immedicately transfer your feet to a hot wheatbag or hotwater bottle for 5 minutes and keep repeating that for 30 to 45 minutes. Often that can reduce the inflammation just a little. You can do the same with your hands with two bowls of water, one cold and one very warm and see how that helps.

And if you can still get in or out of a bath, try soaking in a bath of Epsom salts at night, it night also help.

And I hope you get to see that rheumy soon.

Hi Timothy,

Sorry to hear of your symptoms, but you’ll get tons of answers and support here!

Nail pitting is a tell-tale symptom of PsA, and I think a lot of doctors look for that in making a diagnosis. Have you examined your nails extremely closely? Because sometimes the pitting isn’t very noticeable, especially if you don’t have the fungus-like symptom or lifting of your nails.

Anyway, hopefully you’ll get some answers soon. Achilles’ tendons are a very common hideout for PsA. And, all your other tendons—those were my main problem!

Good luck!

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Thank you for the great advice, I will try that!

Oops, I meant for that to go to another post lol. I have only done a cursory check of my nails on my hands, looking for obvious signs. I have not checked my toe nails yet, I’ll probably do that today. Thank you for the response!

Thank you for your response, I will give those things a try.

I didn’t see anything in my fingernails but my pinky toe on my right foot (which has the most heel pain) looks a little weird. Some of the other nails look a little weird too.

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They look like my nails and I have PsA.

Heel pain is a constant thing for me, more or less. It has never got really bad though.

Mine has never been really bad but I have had to limp a few times when it got bad. It’s pretty bad in the mornings when I first walk but then gets better as I move around. Guess I need to go see what the doctor thinks. Thx for the reply.

That looks like the fungus-look that PsA can look like. If I dug up old pics of my fingernails, I could show you some of them looked similar to that before I went on Enbrel…

Be sure and show that to your rheumatologist.

Also, at first thought when you mentioned pain in your heels when you first get up, my thought was plantar fasciitis. I had that when I was 40. But that would probably involve the bottom of your heel and instep, too. Maybe, if you haven’t yet, google plantar fasciitis just to compare symptoms, because plantar fasciitis hurts when you first get up in the morning plus every time you sit around and get up again…

I actually found Plantar Fascitis when I googled my heel pain. No pain on the bottom of my foot or instep, just at the back of my heel. Sometimes my right heel throbs with pain.

Ugh! That sounds terrible! Your Achilles’ tendons are definitely inflamed. Will icing help at all?

I was told by a fellow member of the forum that ice will help. Going to freeze water in bottles and try resting my heels on them.

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I really hope it helps you @Timothy88. And also remember the hot/cold thing too. That’s part of PT people call RICE, worth looking that up as well.

If I’ve doesn’t seem to help a lot, try the heat instead. It seems to be very individual - I tend to find that tendon pain responds better to heat (or heat rubs / sprays), whereas swollen joints seem to respond better to ice. I have the back of the heel pain, it’s just started up again in the mornings, when I first get up, it makes me hobble like a hobbit for a few minutes!

Thank you for the advice, and the hobbling in the morning is becoming a common thing for me now haha. When it first started I was trying to figure out what I did to hurt my tendon. But now that I see that some of my toenails look bad and the pain in my thumb joint that comes and goes, and the ever spreading psoriasis, I’m beginning to think it may be PsA.

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OMG you have just described my life to a T! I’m so sorry you are dealing with this but it makes me so happy to know I’m not the only one. For MANY years it has been blamed on my weight. It has nothing to do with my weight. It is this damned PsA. It is in my thumbs, it is in the odd finger joint here and there and I type for a living. My left knee and hip have decided to join in on the fun and my right shoulder is about to go rogue and play too.

The psoriasis is on the front of my shins. I no longer wear shorts as it looks so bad. My scalp has psoriasis and itches something awful if I get sweaty. My toes do swell. My hands not so much.

I will not deal with Methotrexate and it and I don’t play well in the sand box.

All this to say…thank you for sharing and I’m sorry.

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