Is the best treatment for localized PsA activity systemic treatment?
What to do if systemic treatment is still leaving areas of localized PsA activity?
My hands have been really involved this past year. They haven't been this bad in 20 years. I'm on the med merry-go-round, and while some of the meds in the past 2 years have helped greatly with everything else, my hands are still pretty active, and getting worse.
If this continues, what is the best course to treat localized PsA activity? I've never had one area stay this active while everything else improves.
So here's a question to think about. . . . Is it now PsA causing the pain/damage to your hands? In other words, is the current pain that is in your hands definitely related to inflammatory disease, or could it now be severe osteoarthritis caused by damage? Is it pain from damage that already occurred, but is not necessarily continuing?
I hope you can get to the bottom of this. I know you've been at this a long time already.
I've had hand x-rays recently, and it's not OA, still obviously the PsA. The pain seems to be from current activity (it is directly related to redness and swelling and stiffening of various hand joints).
Fair enough. Obviously for immediate relief, you know all of the drills already. Cold therapy would be better for active inflammation. Have you tried hand therapy as well? Ultrasound and other treatments may help to quiet things down a bit, while you deal with the systemic issues at the same time.
What is ultrasound treatment? I've heard of it before, but wasn't sure if it was a conventional treatment insurance would cover, or how it works, etc. I'd appreciate any information you, or anyone else, has on that.
I'm doing the usual hand things, alternating hot and cold (cold only works for the hot swelling times), keeping hands stretched and mobile, compression and stabilization when needed, etc.
Do steroid injections work for hands? I would worry about degrading my joints if I have to keep having it done. On the other hand (ha), I've never even had it done once, so I shouldn't put the cart before the horse.
Stoney said:
Fair enough. Obviously for immediate relief, you know all of the drills already. Cold therapy would be better for active inflammation. Have you tried hand therapy as well? Ultrasound and other treatments may help to quiet things down a bit, while you deal with the systemic issues at the same time.
I had ultra sound done at The Hand Clinic in Burlington, Vermont. They also did something called Ionaphoresis (though I am not sure of spelling). It is a type of PT but usually managed by orthopedics not rheumatology. Ionaphoresis entailed an injectable steroid that was used through the skin which minimized side effects. My insurance covered it. I still had trouble with trigger fingers but it did reduce the swelling in my wrists. If your PsA is under good control everywhere else your hands may need special care like this. But make sure your disease elsewhere is well controlled which is hard to detect as it is not always painful.
Marietta, before I was diagnosed, about 11 years ago, orthopedic Dr. Gave me a steroid injection in thumb joint at side of hand. The pain was so intense, I thought I would pass out. And I have a high threshold to pain. Still remember it to this day. Anyway, it did nothing to help, so when I returned he passed me on to a rheumatologist where I was diag’d and started treatment.