New member


My consultant suspects I have PSA as over the last 12 months I have experienced swelling in several fingers and toes. MRI scans show some deterioration. There is no redness and no pain.

He recommends I start on MXT.

Obviously I'm shocked and worried that I need to start this treatment.

Is it possible that the disease can have a slow onset and should I wait until I get more severe symptoms or is the damage occurring without the pain. Should I wait and monitor the progress with another MRI scan? HELP

Moz, welcome! I’m glad you found us, and great that you are posting. My immediate reaction to your question is “Wow, how interesting. No pain, and a consultant rheumatologist who is suggesting methotrexate.” The advice that most of us here with the PsA t-shirt give is “Fear the disease, not the drugs.” The reason is that you are dealing with a stealthy condition – it sneaks around, masquerades as other things, and the pain might be tolerable. And while you’re thinking that you can put up with it, it can be damaging your joints. Some of us have also experienced a sudden escalation of disease activity, and that is not the time to be starting a treatment with the hopes that, in a couple of months, it will start to work. It sounds as if your consultant is wanting to nip your disease in the bud. You are very very lucky.
As one whose went undiagnosed for many years, and then ended up with a very conservative rheumatologist, I salute your consultant! Besides recommending a healthy fear of the disease, a lot of us here suggest accepting the most aggressive treatment that your doctor is willing to give you. I won’t bore you with the details (you can read them on my profile), but let’s just say that you don’t want to end up like me.
Have you found the Newbies’ Guide yet? There’s lots of food for thought there. And I’m sure this thread will fill up with other thoughts and suggestions before long.
All the best to you, Moz!

It sounds like you saw a good doctor. There is no way to know exactly how the disease will progress. The idea with methotrexate and other DMARD s is to slow the progression. If you are already showing signs of damage, then I strongly encourage you to get on a DMARD. Uncontrolled inflammation leads to uncontrolled damage, and there is no coming back from that. Damage can and will occur whether there is pain or not.

My mother had a fairly slow unmedicated progression, primarily on her fingers. After almost 20 years she was diagnosed with PsA. Her fingers are destroyed in ways that are rarely seen any more, due to advancements in meds. She is currently scheduled to have multiple replacements and visions in her fingers.

My own progress of the disease has been relatively slow, with primarily soft tissue damage. Even with being medicated, I have sustained a good bit of damage. We have a saying here: Fear the disease, not the meds!

I couldn't agree with it more. There is lots of great reading, especially the new members section. It's a lot to take in, but I can't even tell you how thankful I am to have found this group!