I’ve had psoriasis for 10-15 yrs and had a dodgy back for a decent number of years due to muscular instability largely due to flat feet. However, for the last year or so I have been particularly stiff in my spine, especially lower and worst when I wake up in the morning. It often clicks and aches and causes tendon pain up my back and I have been doing physio and osteo to no avail. I woke up this morning and thought, oh my god, I knw what it is. I googled PA and it seems clear that it is entirely consistent with PA spondylitis. I am away wi work for 2 weeks but will go back to my doctor when I get back and ask for tests. Is is normal for the spine to be the first and only part of the body to be affected? I have no issues with my hands, feet, knees or elbows? It is a bit tricky as in the military and really not keen for this to affect my job. Any thoughts most welcome, must admit it has knocked me back today as the potential consequences.
My Rheumetologist said that PsA can hit in different places for people, there is no one type of onset pattern. I have it in my lower back and deal with the same pains in the morning. But I also have it in my feet, hands, elbows, and shoulders so it is different for everyone. I would definitely tell your DR. and have them do a sedimentation rate blood test and to test for the C-reactive protein. Those will give them a good Idea. I hope you get some answers and start to feel better.
Look up ankylosing spondylitis.
Thanks, the thing I am not sure of yet is whether this is necessarily going to be life changing or not. Is it possible to have mild spondylitis related to PA or is it going to be totally debilatating. Impossible to know whether it will be or not but can it be relatively mild in effect or well managed long term?
I was first diagnosed with RA and then PsA when my fingertips began swelling. The funny thing is that I don’t have psoriasis? My rheumy said you don’t always. But what I do have is the arthritis pain in my lower back, hips, knees, and elbows… wrists and fingers. I agree there is no set pattern and I really feel like a lost soul floating between my RA Warrior group and this one. I never had the courage to post anything until yesterday, though, when my despair level reached a level I had never before known. I really needed to hear from someone who knew my pain. Even though all our stories are different, I think we all know what it is like to look normal and feel OLD and STIFF and exhausted… And to have everyone say the wrong things.
You don't HAVE to display skin psoriasis to be diagnosed with PsA. That is my case. this clincher for my rheumy was that my fingernails were pitted and lifting a bit from the nail bed.
That is sooo true
TigerGirl said:
I was first diagnosed with RA and then PsA when my fingertips began swelling. The funny thing is that I don't have psoriasis? My rheumy said you don't always. But what I do have is the arthritis pain in my lower back, hips, knees, and elbows... wrists and fingers. I agree there is no set pattern and I really feel like a lost soul floating between my RA Warrior group and this one. I never had the courage to post anything until yesterday, though, when my despair level reached a level I had never before known. I really needed to hear from someone who knew my pain. Even though all our stories are different, I think we all know what it is like to look normal and feel OLD and STIFF and exhausted... And to have everyone say the wrong things.
Thank you. So is it possible to have mild spondylitis related to psoriasis that is manageable long term without drastically changing quality of life, either with or without meds?
Here's the thing. It's a definite maybe. The problem is that inflammation does not always cause pain, even while it can be causing damage. The long-term damage will cause pain, that won't be manageable any longer through use of disease modifying meds or biologicals. This is definitely something you would want to talk about with your doctor. If medication is called for, it increases your chances of not having a drastically changed quality of life.
Hayden77 said:
Thank you. So is it possible to have mild spondylitis related to psoriasis that is manageable long term without drastically changing quality of life, either with or without meds?
Sorry for the refresh. That’s useful Stoney, it seems to me that the use of bio modifiers early is high risk for side effects but not doing so is high risk for long term damage. Difficult. Will DMARDs also help stop long term damage in the spine?
Autoimmune diseases run together so although this is possible, your doctor will probably get an HLA-B27 (if they haven’t already) to rule out other spondyloarthropathies.
That's the idea. Some rheumy's start with the big guns (biologics) while others will see how just a DMARD does. I've been on DMARDs for almost 5 years, with no biologic. But these should be able to also halt or slow the progress of the disease, through modifying your immune response.
Hayden77 said:
Sorry for the refresh. That's useful Stoney, it seems to me that the use of bio modifiers early is high risk for side effects but not doing so is high risk for long term damage. Difficult. Will DMARDs also help stop long term damage in the spine?
Being in the military I imagine DMARDS are less likely to compromise staying in the job than biologicals, just fingers crossed it can be managed early and doesn’t get too bad, not yet anyway. Will MRIs be able to monitor whether the meds are preventing long term damage or not really? Sorry for all the questions!
I would say a MRI should show if there were changes or deterioration. Referrals are not given out very often for these to be done. You may have more chance being in the Military. I recently read on a net Medi site that HLA-27 test can show up in 80% of the population. Google it. You may even have this or AS if the HLA-27 is negative as well. My HLA 27 is negative and because of this the Rheumy just dismissed these reasons for my lower back pain due to my previous back history but I never had the pain in the Sacral and Tail bone area that I have had over the past few years. It can be difficult getting the right diagnoses. It only verifies what we are thinking sometimes. With or without a diagnoses, often the treatment is much the same.
My psa started in my spine. It was no where else for years. It wasn't even in my SI joints (or at least I didn't feel pain there.) It sounds like you have a nice early start because of your self-diagnosis. I wish I hadn't ignored my symptoms for so long. Now I have psa in my SI joints and leg ligaments in addition to the rest of my spine. I'm FINALLY on the right meds. I'm 54 and the psoriatic messed around with the osteo in my spine to make it worse. However, it's bearable. Go aggressive with your treatment early. I wish I had. I can only wait and see if I can improve. But, I still work full-time and am trying to stay positive.
I'm curious what your reasoning is for this. Many people have zero side effects from the biologics, but many DO have some side effects from the DMARDs.
Hayden77 said:
Being in the military I imagine DMARDS are less likely to compromise staying in the job than biologicals,
I was on biologics for years with little to no ill effects. But with mtx-I felt horribly nauseated.
And for some people the spine is what's affected more. Each person is different. OR it might not be PsA related. It's best to go to the doctor and get checked out for sure. But if you're already being treated for PsA then I'm not sure if they can do anymore at this time.
I do know the most devastating form of PsA is arthritis mutagens which doesn't affect the spine (to my knowledge).