Hi, I've been repeatedly diagnosed with PsA yet do not fit the pattern. The fingers on my dominant hand are grotesquely swollen at the knuckles. It started with the first two fingers two years ago and is speading to the remaining two. I've tried acupuncture, anti-inflammatory diet, sulfasalazine and enbrel with no effect. I had a second MRI last week and again they say it looks like PsA. I've read many posts but can't find anybody like this. They want me to try yet another biologic...not sure if I should keep taking these powerful drugs. Thanks for any insight you can provide and I wish you all well. I feel bad even asking this when my symptom is so minor compared to what I've read.
I suppose one way of looking at this is that the drugs you've been taking may have prevented more extensive joint involvement.
PsA is a systemic disease i.e. it affects the whole body. I'm wondering whether you have, or have had, other symptoms such as fatigue and any stiffness in other joints. If 'all' you've ever had is swollen fingers without feeling generally unwell or exhausted, without raised inflammatory markers (which not everybody with PsA gets), and without any stiffness etc. etc. then perhaps it would be a good idea to ask your rheumy to explain his or her thinking to you very clearly. In your position I would ask them exactly why I was on biologics.
I don't think I've heard of many people getting on a biologic before their symptoms worsened, but it could be that you're actually one of the very lucky ones who has! One possibility is that they think you have a type of PsA that puts you at considerable risk of joint damage. I think you are going to have to quiz your rheumy good and proper!
My mom’s primary damage is in her hands. After about 15years or so of being undiagnosed and untreated she is now on methotrexate and enbrel. She didn’t even realize just how poorly she really felt until the meds started working. She has a lot of damage in her hands, but is feeling better than she did years ago.
You didn’t say how long you were on the sulfasalazine or Enbrel. Out can take 3-6 months for many of these meds to start working. I agree with Sybil. Lots of questions for the doctor.
I was on sulfasalazine for six months and Enbrel for four. I don't feel unwell but who knows? She is the third rheumatologist I've seen and she admits, along with the others, that she's stumped. I'll try one more drug and go from there. Thanks for the advice.
This is very concerning to me. Those kinds of physical changes along with radiographic evidence is usually indicative of one of two forms of PsA:
Distal interphalangeal predominant. This type of psoriatic arthritis is most commonly found in males, but is somewhat rare. It affects the distal joints, which are the small joints closest to the nails on your hands and feet. Your fingernails and toenails are likely to show symptoms of psoriatic arthritis such as ridges, pits, and a yellowish-orange color.
Arthritis mutilans. This is the most debilitating and disabling type of psoriatic arthritis. It is the least common – only about 1 to 5 percent of people with psoriatic arthritis have arthritis mutilans. The small bones in your hands, especially the fingers, the feet, and possibly the neck and back break down, causing permanent deformity. It can be quite painful
Severe irreversible damage can come on very quickly. These are the most aggressive and crippling forms of Psa. Aggressive treatment is critical. This isn't a matter of one more drug. or "minor symptoms" There should be no confusion as to what needs done. You most definitely need powerful drugs. The damage is irreversible and resulting pain generally untreatable
Thanks for your response. I will bring up both terms when I next see the Dr. this Wednesday.
All the best to you Enigma. I'm hoping you'll get back to us with an update after you've seen your doctor.
Enigma said:
Thanks for your response. I will bring up both terms when I next see the Dr. this Wednesday.
I certainly will!! Thanks for your concern.