Hi, I’m 53 and I haven’t yet been fully diagnosed. My next rhem appointment is scheduled for the end of this month but I am just impatient to know and have been trying to self-diagnose!
I have had nail onycholysis on my fingers for quite a few years now. Also very very mild patches of psoriasis, Last year I got Achilles tendonitis. This was particularly upsetting because I love zumba dancing and I eventually had to stop dancing the pain was so bad.
I then began suffering from a pain in my lower left back - which orthopedic dr. said was “only muscle pain”. Then the morning stiffness - knees, feet, back and hand started and became worse. Can’t sit or stand for long, but can’t walk or run for long either.
After going back and forth to the dr. I eventually was referred to a rhem who sent me for tests.
I know I should wait to see what the specialist says but I am curious to know now - that’s how I found this community - by googling!
My blood texts were normal apart from high TSH ( I suffer from hypothyroidism and take meds but have become a bit unbalanced) and high MPV.
Xrays show “mild osteoarthritic changes in the hip, knees, hands”.
US of feet shows fluid on tendon.
I know there is nothing I can do at the moment apart from wait for my appointment but I was wondering what you thought – is it “just” OA or maybe PsA?
My PsA pain felt more like muscle pain, too. I also had the fingernail changes and lots of stiffness in areas around my joints and my mid and lower back. I’ve had moderate psoriasis for over 40 years now (well, since I’ve been on Enbrel for 2 years the psoriasis is better controlled). But, don’t let doctors tell you it’s not PsA because it seems to be muscle pain. That’s exactly what I thought–pain comes from tendons and ligaments connected to joints and radiates into the muscles (I think). Have you had any prednisone? Oh gosh, I see you can’t stand or sit long and getting out of bed in the morning is painful, too! I have normal blood tests also. Have you ever had a prednisone taper? When my doctor gave me prednisone for a few days I felt on top of the world. When I started Enbrel, there was unbelievable improvement. I also found this site by googling, and it has been so helpful for me. Good luck and I hope your rheumy gives you the right diagnosis so you can get on with good treatment! Hang in there!
Thanks - sorry to hear you also suffer. I haven’t tried any treatment yet…waiting for the right diagnosis. Next appointment not until 31 Oct so frustrated that I can’t start on treatment before. I am not a very patient person! What most upsets me is having to stop dancing because of my feet. I hope that treatment will allow me to go back to this cos I miss it so much. Thanks for your support!
Hi yael! You could have both OA and PsA. Psoriatic arthritis can set the stage osteoarthritis. You can also have completely normal blood work with PsA. In terms of stiffness, morning stiffness from OA is fairly short lasting, whereas from PsA can be longer lasting, like an hour plus.
Yael, your experiences parallel those of many of ours here. OA is wear and tear damage. For some people, that’s a simple case of ageing and joints wearing out. For others, it’s damage caused by disease. Saying that you have mild OA means you have mild damage. It could just be from getting older, but that damage can also be secondary to disease. Sometimes the pattern of OA damage is distinctly PsA, such as the “pencil in cup” pattern in fingers. At other times, it looks just like ordinary wear and tear damage on an x-ray. My own opinion is that if they think you have PsA and you also have visible damage, the safe assumption is that it is disease damage. And visible damage would have me asking for the most aggressive therapy I could get. To assume it’s “just” OA is flirting with more damage.
The frustrating thing about PsA is that there are no tests for it. In fact, a lot of us have blood work which is all in the normal range. The diagnosis is done on clinical evidence: skin and nail symptoms, pattern of swelling and pain. Unfortunately, a lot of docs aren’t able to connect the dots of PsA.
Foot pain is very typical, but foot pain is very often blown off. Everyone has sore feet, right? Well, Yael, please continue to complain about your feet until doctors take it very seriously and you get therapy that arrests the disease. Knees and hips can be replaced. Foot damage is extremely difficult to set right. I didn’t complain enough and for me it is too late.
A warm welcome to you! We are glad that you joined us, and we hope that you are too.
I’m wondering whether you experience any fatigue or times when you feel downright awful. I was sent to an orthopaedic surgeon who diagnosed a bit of OA (a bit of knee OA that was causing sizeable swelling). Then when the other knee joined in my GP did blood tests that showed high levels of inflammation. I still had to go back to my orthopaedic guy as opposed to rheumatology, that was the protocol apparently. As soon as I mentioned that I’d started feeling ‘decidedly unwell’ he repeated that phrase back to me with furrowed brow & referred me straight on to rheumatology.
I’d imagine that as you have hypothroidism you might feel tired or ‘blah’ sometimes anyway, which could confuse the picture if you also have PsA. However these systemic symptoms would be worth emphasising if they are part of the picture. Incidentally, I had signs of hypothyroidism initially but the numbers normalised once I started treatment for PsA. My rheumy told me that inflammatory arthritis can cause the thyroid to ‘wobble’.
Don’t dismiss anything as irrelevant when you see the specialist again. PsA can be a tad complicated. But whatever your eventual diagnosis is, I hope you get to dance again. Good luck!
Thank you all so much for your replies. It’s good to get input and support. My husband is supportive but I don’t want to go on about it to him because he thinks I’m a bit obsessed about my aches and pains at the moment. He’s probably right and I should relax before I get fully diagnosed! Anyway I will let you know when I get the final verdict. You all take care!
I hope you don’t mind my jumping in on this thread. I’m also at the is it osteo or psoriatic stage. I had xrays done finding damage in all 8 fingers, two toes, and si joints. Even though I have psoriasis and have felt tired and definitely not myself for some time, my rheumy feels this is all OA, I felt that as soon as my blood work came back normal she lost interest. Keep us posted on what happens next, good luck with your appointment
Of course I dont mind!!! This diagnosis thing is a prob. I am not sure if the xray can differentiate between OAandPSA. I really hope you get the correct treatment but if you’re not satisfued you shpuld try a different dr. Still waiting for my appointment.
Hello again - thought I’d check in after my Dr.s appointment. Well I expected a “you;ve got…” but instead she wants to do another test. MIR. I suppose it’s good that she is thorough but I’m impatient to know if I have PSa or not. She prescribed Celecoxib for the meantime so I hope that helps!
Yael, have you gone to a dermatologist for an opinion on your nail issues? It seems vain to see a specialist for a few nail cracks, but having a derm say “yes, this is psoriasis” can sometimes “nail” the diagnosis. Besides, when I went to the derm, she found plenty of evidence of psoriasis that I hadn’t noticed.
Sometimes PsA shows its distinctive features on X-rays. If that’s the case, though, you would have to be lucky enough to have a person reading the X-rays who knows the quirks of how PsA might look on an x-ray. An MRI can often be helpful because it can show inflammation before it has caused damage.
In textbook cases, diagnosis can be simple enough. (Although we’ve met people here who lived for years with a textbook case that eluded diagnosis.) In less obvious cases, it can take a long time and several doctors to figure it out.
Whether it’s PsA or something else, when the diagnosis is presented, you need to be able to say “yes, this makes sense to me”. If it doesn’t make sense to you, the diagnosis and/or doctor selection process isn’t done. Persist until you can say that.
Thanks Seenie, yes the dermatologist did say I have nail psoriasis but I understand that the aches and pains can be “just OA” even if I have psoriasis. I have very very mild psoriasis. I suppose at the end of the day its a matter of getting the right treatment. Good news though - I found an amazing dancing fitness group called NIA - it is non-impact aerobics and I can still dance - even with all the pain!!!
Hi yael. Your rheumy does sound thorough, frustrating though waiting may be.
You know, the severity of your psoriasis isn’t an issue, just about every source on diagnosing PsA mentions that. Just having it at all makes psoriatic arthritis more likely & it is quite possible to have mild (very mild) psoriasis but severe PsA & vice versa. I think, not 100% sure, that having nail psoriasis makes PsA even more likely.
You’re right of course, you may have OA that is unrelated to PsA and that might be the end of the mystery. But we have nasty, suspicious minds round here, something to do with seeing so much ‘OA’ turn out to be PsA in the fullness of time perhaps. Plus of course the treatment for the two conditions has different aims … the stakes are higher if PsA is missed.
Glad you’re hitting the dance floor again. I love dancing too, just don’t seem to get much opportunity. Good luck, keep us posted.
My mom was told that all of the damage in her hands was OA for years. Her fingers are horrible! She was diagnosed with PsA a few years ago, and shockingly all of the other aches and pains have turned out to be PsA too, as she is much improved from her “age related” aches and pains. Oh, and while she doesn’t have skin psoriasis, she does have nail psoriasis with totally normal bloodwork. I have minor nail changes and virtually no skin psoriasis, and totally normal blood work. Being pushy may be useful, as it can ensure that you are getting proper treatment and minimizing damage.
the diagnosis. Besides, when I went to the derm, she found plenty of evidence of psoriasis that I hadn’t noticed.