I’m a 52 year-old male living with chronic pain in both legs, knees and occasionally elbows. It started about 15 years ago as foot pain and eventually travelled up both legs to include my knees. It feels like a combination of bone and nerve pain and it’s always worse from weight bearing. I’ve seen countless specialists over the years and every single test (x-rays, blood
tests, MRI’s, bone scans, etc.) have come up completely normal. A rheumatologist I met with recently suspected Enthesopathy as the main problem. No one has ever mentioned PsA to me. My main question is this: Does anyone out there have a similar experience to what I explained, and is it possible to have PsA without any visible signs of swelling or redness? thank you
Hi GRS. Is there anything that makes you suspect PsA? Have you had, or do you currently have, any skin issues at all? Many of us look back and recall having ‘dry skin’ or ‘dandruff’ or tiny itchy patches of skin that may well have been psoriasis. And also PsA can precede psoriasis. Apparently about 80% of people with PsA show psoriatic nail changes so how are your nails? How about family history? Anybody with psoriasis / PsA / any other autoimmune disease amongst your close relatives?
Certainly a lot of members say they don’t have visible swelling or redness. I’ve had significant swelling but my joints don’t usually look red. And there is no diagnostic blood test for PsA, many of us have raised inflammatory markers at times but quite a few don’t.
Whether or not you have PsA, it sounds good to me (though I can see why you’re frustrated!) that imaging doesn’t show any damage.
Then there’s morning stiffness … do you take a fair while to get moving in the morning? And does your pain ease off with movement generally? That’s about all I can think of right now! Have you asked a rheumatologist about PsA? If you haven’t brought it up as a possibility, then that would seem the way to go. Whatever is happening, there is one thing you definitely share with many of us who have PsA and that is a long & winding road to diagnosis, it’s a really difficult thing to endure. I do hope you get a diagnosis soon but you are almost certainly going to have to persevere. Good luck, I wish you well.
thanks sybil,
you might be right. based on your description that’s probably not what I have. my next step is an MRI and I’m also going on 40mg of Prednisone for 2 weeks so I’ll see what I find out.
thanks for your support
Enthesopathy certainly sounds resonable given no other signs of inflammatory disease and your description. I’m curious if you have seen an ortho or good podiatrist. It could be as simple as some heel lifts or splinting to let the tendons heal. Its a condition that can last for years if untreated. PT can do wonders as well. There has also been a fair amount of sucess with Extracorporeal shockwave therapy (ESWT) for treatment of plantar fasciitis. The cause is chronic traction of the Achilles tendon on the calcaneus. Contracted or shortened calf muscles (resulting from a sedentary lifestyle and obesity) and athletic overuse are factors. No it won’t show on any imaging. However if you do have a massive improvement while on predi, that could mean its caused by a spondyloarthropathy
Thank you, that’s helpful. I’ve gone to many, many top specialists over the years. My first call was to the head of podiatry at the hospital for special surgery in NYC because it started as foot pain. He prescribed orthotics but that didn’t help. Then I met with some of the top the orthopedist and knee specialists and they couldn’t find anything structurally wrong either. I eventually had neurologic tests, Lyme tests, and met with several top rheumatologists. The only thing they
found was a mild case of small fiber peripheral neuropathy but that doesn’t really explain the chronic joint pain.
Spondyloarthropathywas mentioned at one point and I know my test (HLA-B27 levels?) came back negative but another doctor told me that those tests aren’t always 100% accurate. Do you know much about the condition or how to diagnose it? From what I’ve researched, it seems like that could be what I have
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GRS, if I’m reading you correctly, sounds like you think spondyloarthropathy is something separate from PsA whereas that is the umbrella term for the family of diseases which include PsA and Ankylosing Spondylitis. Not everyone with one of these diseases has the HLA B27 gene.
HLA B-27 is only significant when positive. It just saves time if it is. Yes PsA is a specific type of spondyloarthropathy, but for better than 6 years now Undifferentiated Spondyloarthropathy or just the word spondyloarthropathy has been an acceptable diagnoses M47.9 is the ICD-10-CM code that can be used to indicate the undifferentiated diagnosis M45-M49 wheel it down a bit more.
I tested negative for HLA -B-27. Does that mean anything? Should I still not rule out spondyloarthropathy as a possibility?
Not really. A positive test is not definitive either. There are a number of other conditions that need to be present. Spondyloarthropathy is what they call a differential diagnoses.Differential diagnoses is "the process of weighing the probability of one disease versus that of other diseases possibly accounting for a patient’s illness.
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Should I still not rule out spondyloarthropathy as a possibility?
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No you shouldn’t