Hello, New with Questions

General
1

Hello everyone. Thank you for allowing me to join. I guess I'll just dive right in with my story and see what you all think about it:

I was a young child when I developed an oozy, sticky rash behind my ear. It seemed to run the length of my ear or ear(s). At the same time I developed crusty stuff on my face and my eyes were inflamed. My pediatrician prescribed all sorts of things for me and I remember my parents almost having to sit on me to get the medication in/on me. It was a recurring thing. At that same time I was diagnosed with anemia and I had pains somewhere in my legs, but I don't remember exactly where.

Fast forward to today. I have inflammation in my eyes and have been treated for it with antibiotics for a year now. I don't think the antibiotics have done a thing to help them. The inflammation is called Meibomitis and I know it can be associated with Psoriasis. Also, I am losing finger and toenails without any pain. Funny (really not funny) that I lost my first toenail in the 1980s and that's when the pain began. The nails separate from the bed but turn white along the edges before falling off. Sometimes the nail bed is very sticky or gooey, much like my ears as a child. My fingernails are pitted, ridged and very fragile. They constantly split vertically. I also have very dry, scaly skin.

I have what may or may not be psoriasis inside my right ear. It is very crusty looking and embarrassing. My Dad has Psoriasis and my Grandmother had very painful "osteoarthritis" in her fingers (I don't recall her complaining about any other pain except for her fingers). Her fingers were extremely deformed. The deformities do not seem to fit osteoarthritis.

I am extremely stiff, in agonizing pain, and have been since the mid 1980s. My pain has progressed, but I am not even pacified by my docs. I try to move, but am most comfortable lying in a recliner. I am not a lazy person by nature, but the pain in my lower back is agonizing if I do too much. "Too much" is vacuuming or doing laundry. I also get severe neck stiffness with agonizing pain. Pain and swelling in my fingers. My elbows are also very painful, as are my hips. The pain jumps from one place to another. Tendons or ligaments are currently flaring up again in my right thigh, in the fold adjacent to my hip.

My x-rays and MRIs are awful. I have severe bone spurs, arthritis, stenosis, something wrong with my facet joints, the list goes on and on. I cannot take anti inflammatory meds because I have Barrett's Esophagus — a precancerous lesion in my esophagus. I almost forgot: my palms go through cycles where they itch like crazy and start peeling off. The skin on my hands wrinkles up after being in water for just a few minutes. I don't know if any of this hits home, but thought it wouldn't hurt to reach out to you.

I also have Sjogren's Syndrome and an elevated c-reactive protein.

My biggest question: Can a person have Psoriatic Arthritis with mainly nail involvement and with very little skin involvement? Do I see dermatology or rheumatology first?

Thank you in advance,

WW

2

Yes. Some PsA folk rarley have skin involvement. Nail involvement is almost a slam dunk for Psa

See which ever one you can get into first. Depending on where you live Dermos are easier and can if necessary get you to the rheumy a lot faster. If its a really GOOD dermo they may even be able to skip right to a biologic regime skipping all the other stuff.....

3

It sounds like I may be barking up the right tree. Finally. Is PsA notorious for escaping diagnosis? If true, is it because our GPs or internists are unfamiliar?

Thank you very, very much!

4

Yes, it is. There is no "test" But here's the criteria:

http://www.medicalcriteria.com/site/index.php?option=com_content&view=article&id=256%3Areupsa&catid=79%3Arheumatology&Itemid=80&lang=en

Wandering Woman said:

It sounds like I may be barking up the right tree. Finally. Is PsA notorious for escaping diagnosis? If true, is it because our GPs or internists are unfamiliar?

Thank you very, very much!

5

Wow. So much criteria. I'm thoroughly confused. Best if I go through it later. Thank you again.

6

There are different ones theis is the most common used:

The CASPAR criteria for psoriatic arthritis consist of inflammatory articular disease (joint, spine, or entheseal) with >/= 3 points from the above categories. The sensibility is 98.7% and the specificity is 91.4%.

  1. Evidence of current psoriasis, a personal history of psoriasis, or a family history of psoriasis (2 points)
    • Current psoriasis is defined as psoriatic skin or scalp disease present today as judged by a rheumatologist or dermatologist.†
    • A personal history of psoriasis is defined as a history of psoriasis that may be obtained from a patient, family physician, dermatologist, rheumatologist, or other qualified health care provider.
    • A family history of psoriasis is defined as a history of psoriasis in a first- or second-degree relative according to patient report.
  2. Typical psoriatic nail dystrophy including onycholysis, pitting, and hyperkeratosis observed on current physical examination (1 point)
  3. A negative test result for the presence of rheumatoid factor by any method except latex (1 point)
  4. Either current dactylitis, defined as swelling of an entire digit, or a history of dactylitis recorded by a rheumatologist (1 point)
  5. Radiographic evidence of juxta-articular new bone formation appearing as ill-defined ossification near joint margins (but excluding osteophyte formation) on plain radiographs of the hand or foot (1 point)
† Current psoriasis is assigned a score of 2; all other features are assigned a score of 1.

Get 3 or more points and you are there!!!

Here's a nice article talking about why its so hard to Dx

7

Thank you so very much for the clarification. I'd say I probably have at least 3 points but probably more. Also, I have mild subungual hyperkeratosis. The skin grows out beyond the nail and it is pretty hard, and painful if I try to remove it.

8

OOPs forgot the article:

http://www.musculoskeletalnetwork.com/display/article/1145622/2083701

9

Hi, You can develop Psoriatic Arthritis with very little psoriasis - and it sounds like you do have it in your ears - not uncommon. Also, people can develop PsA before they have any signs of psoriasis. I would see a rheumatologist first. I hope this helps.

10

Great articles thanks for posting

tntlamb said:

11

Yep see a rheumy... I have PsA with little Psoriasis ( but you have more involvement than even I)... don't wait any longer, as it sounds like you could use some relief!!!

12

Hi, WW, I’d say make an appointment with both the rheumy and the dermie, because the rheumy will probably want a definitive diagnosis on your psoriasis anyway. Go to whoever you can first, and my guess is that whoever you see first will start your treatment (and either will probably start with the same meds). But I think you need to get on this as soon as you can.
Good luck, and welcome to the board. I’m glad you’re here, but sorry you’ve joined the club. :slight_smile:
Seenie

13

I’m very curious how many others have the palm piecethat WW describes? I too have that part of it. I have no psoriasis but have been diagnoses with PsA due to text book presentation and family history. I do Methotrexate and Enbrel and am finally feeling like I might be making some headway. I take it very easy though but try to stay as active as possible. The dermatologist had a name for the palm peeling unrelated to psoriasis but I still feel it must coorelate.

14

The skin on my right thumb slightly overgrows the nail now. That thumb nail is very affected by psoriasis.



Wandering Woman said:

Thank you so very much for the clarification. I’d say I probably have at least 3 points but probably more. Also, I have mild subungual hyperkeratosis. The skin grows out beyond the nail and it is pretty hard, and painful if I try to remove it.

15

You guys are all awesome. Thank you so very much for the encouragement and information. I've suffered with agonizing pain since 1983 and I hope relief is around the corner. The pain so bad I'd almost rather die. How long does it take for medication to help? Or am I expecting too much since I've gone untreated for 29 years? I have a derm appt. in January and rheumatology appt. is Monday the 17th.

I'm attaching a picture of my nails.

715-nails.jpg (366 KB)
16

Ridging, receding free edge, salmon oil stain ... looks like it to me, but it's very subtle. And I'm no dermatologist, that's for sure. But when I went to my GP and said, see this nail, it's psoriasis, she laughed, rolled her eyes and said "It'll be interesting to see what the dermatologist says." So ... I'll be interested to know what the dermie says! Say, how are your toenails?

Nobody can predict how you will respond to meds. That's a wait-and-see.

Seenie

17

Seenie,

The doctor snort and eye roll; I know it soooo well. My nails have looked much worse. My toenails are gnarly. Very thick, pitted, and have white spots all over them.

Seenie said:

Ridging, receding free edge, salmon oil stain ... looks like it to me, but it's very subtle. And I'm no dermatologist, that's for sure. But when I went to my GP and said, see this nail, it's psoriasis, she laughed, rolled her eyes and said "It'll be interesting to see what the dermatologist says." So ... I'll be interested to know what the dermie says! Say, how are your toenails?

Nobody can predict how you will respond to meds. That's a wait-and-see.

Seenie

18

Make sure you display those toenails! My GP really is a lovely woman, but when she hears hoofbeats, as far as I'm concerned, she never considers zebras. And I'm a zebra. Go to google images, WW, and search for "nail psoriasis". What you see there will be very interesting. I did that (about 15 years after first showing my GP a gnarly toenail, but only after being diagnosed with an mystery erosive arthritis). There I found a good match for my index finger, printed it, and took it for show and tell. Doc laughed and said "you're really good at cut and paste, aren't you?". She was teasing, of course. But when I went to the dermatologist, SHE did not laugh. The dermatologist (true to her reputation) went into a screaming tirade, an absolute hissy fit, about how "these GPs need to take things like this seriously and not automatically assume that anything under the nail is fungus, I don't know how many times I have to tell them that, they never seem to learn and people walk around with this for years and end up like you ...". I'd been forewarned about this woman, so I had a hard time stifling my laughter. But the point is, subtle nail changes can be an important diagnostic clue. And to think that I always felt vain, silly, and apologetic for periodically pointing out my minor (?) nail issues to the GP when her waiting room was full of *truly* sick people. Yes .... those "minor" nail issues confirmed my PsA diagnosis. And if, twenty years ago, someone had figured out that I had psoriasis, they might ... no, shouldn't go there and cry over spilled milk again.


Wandering Woman said:

Seenie,

The doctor snort and eye roll; I know it soooo well. My nails have looked much worse. My toenails are gnarly. Very thick, pitted, and have white spots all over them.

Seenie said:

Ridging, receding free edge, salmon oil stain ... looks like it to me, but it's very subtle. And I'm no dermatologist, that's for sure. But when I went to my GP and said, see this nail, it's psoriasis, she laughed, rolled her eyes and said "It'll be interesting to see what the dermatologist says." So ... I'll be interested to know what the dermie says! Say, how are your toenails?

Nobody can predict how you will respond to meds. That's a wait-and-see.

Seenie

19

Cut and paste? Oooooooo. Grrrrrrrr. I've had some doozies through the years. One documented that I was delusional and imagining my pain. I even went to a very prestigious medical facility in the midwest but no one ever looks at my nails Nails and teeth — such a fundamental way to determine one's health status. Instead we're bombarded with expensive high-tech tests and scans and procedures. . . .

20

I have had cronic pain for 39 years. I fractured my spine. I would continually go to my GP and ask for pain meds. My skin has always been clear. I had problems with my ankles. He sent me to a foot doctor. I ended up in a boot for months because I could not weight bear on my foot. But I have alway had an itch. My wife kept telling my "well put lotion on". A year ago I was in the ICU with parcarditis, No one put two and two together. Finally my GP got tired of me asking for more an more pain meds and sent me to a Pain Management Doc thinking I was abusing. It was the only thing my GP has done to help me. The PM doc asked me if there was any Family history that she should know about. I told her that my Father death certificate said "do to complication to Lupus", and my brother thought he had Lupus and just died of lung cancer. I told her that I have asked my GP for test. My PM Doc sent back to my GP and requested that he do a blood test. I was positive for RA. He sent me to a Rhummy. The Rhummy said I did not have Lupus or RA. He said that I had a Inflammatory Arthritis. My next appointment with him. I didn't get all the way into the room when he grabbed my hands and looked directly at my nails and said I missed them the first go around. You have pitted nails. You have PsA. 39 years latter I am now getting treatment. So you are not alone. I when back to my GP and asked him to please Xray my hips because they hurt. He did. He said "guess what you have alot of arthritis". He is now more willing to help! He saw it finally with his own eyes. Although he still asked me to bend and see how far I can bend. He has no clue what I (we) go through.