This is the story of my feet. My sad, sore feet. The ones that are hard to walk on. Not my two knee replacements, nor my hip replacement nor the hip that is on its last legs. Not the aches, pains and fatigue that my doctor blew off for ten years. No, this story stars my feet.
I complained of sore feet for about five years. It was “get orthotics”. A couple of years later, my feet were still sore. A sports meds doc said it was metatarsalgia. Get new orthotics. The pain continued and got worse. X-rays showed nothing. Then I couldn’t stand it any more, and when the doc said “maybe get some new orthotics”, I bolted to a podiatrist. She took an x-ray and found erosions, which led to my being diagnosed with Psoriatic Arthritis.
The rheumatologist took the view that my case was mild and she dispensed the usual DMARDs in succession at three-month intervals. They did very little, although Arava did help minimally. The whole time, I was absolutely terrified of further foot damage, but I felt that I had to trust her. I was, after all, not qualified to practise rheumatology, and she was. At the end of the year of experimentation, I asked for a biologic. She refused, saying my disease didn’t warrant that. I wept. Some months later, my Orthopedic surgeon, having looked at my hip x-rays and strongly suspecting inflammatory damage, wrote her to ask that she reconsider my treatment. No action. At that point I sought a second opinion at a specialty PsA clinic. Their assessment? Severe disease, considerable damage. Their prescription? A biologic, asap. At least at that point, my feet had not got appreciably worse than they had been the year before.
Six months after starting the biologic, I had more x-rays. These, though, showed significant deterioration of my feet from six months before. I suppose it must have happened during the time that the biologic was not yet having its full effect on me. I ended up seeing the best foot and ankle surgeon in the region. I fully expected that it was going to take sharp instruments and a lot of sutures and plaster to get me walking normally again. The surgeon did confirm that my feet were badly damaged by PsA. I already knew that. But I had not expected that they would be so badly damaged that no surgery could be done. I am left with pain killers and keeping my fingers crossed that the PsA-damaged bones will fuse themselves into a pain-free lump. My inability to walk properly is permanent. Forever. To say that I was upset would be an understatement.
Early and aggressive treatment gives the best outcome. Those are the words of Gladman and Chandran, and the watchwords here. When would “early” have been for me? I think early would have been when my feet started to hurt, about five years before I knew I had PsA. By the time I saw the rheumie, and already had erosions, it was already L.A.T.E. In retrospect, she should have cut to the biologic chase asap. Instead, we waited. We tried this and that. She misjudged my disease, despite the existing damage. She miscalculated. And it was my feet that were lost.
Treatment. Early. Aggressive. Take notes.