I just had x-rays on my hands, elbows and shoulders because I have been having increased pain in them. All joints had notable osteoarthritis which I kind of expected. But my Dr. is dismissing PsA as a cause of any pain. I can see Osteo causing steady pain with joint use but I get pain when at rest and it comes and goes…sometimes lasting days or more and sometimes just hours and it has little to do with activity. Also, the pain is where the ligament/tendon meets the bone…I can feel it. So what is the relationship between PsA and Osteoarthritis?
Depending on your age and what you’ve done physically, you can have natural OA which you would have got anyway or you can have damage from PsA or you can have both. In certain circumstances the damage from the PsA looks different too. Sadly just because we have PsA doesn’t get rid of the risk of developing coherent OA as we age.
To put it another way, it would be really unusual for a person in their late 20’s or early 30’s to develop OA more so when they have PsA. Therefore the likelihood of the damage identified with that age group being PsA damage only, is higher. And the world over these poor sods are told they have OA damage whereas it’s more likely to be PsA damage. Which might well be deterimental to their PsA treatment as in it’s not stepped up.
However at our age the waters muddy considerably, sadly. It’s hard to tell the difference because we’re older anyway. However PsA can still cause pain in OA affected joints. To say it can’t is illogical and irrational. PsA can still have a party in a joint affected by something else.
And regardless of what causes it, damage is nonetheless damage and fixing it is more problematic for us lot with PsA too.
I’m presently going through this with my right foot. It’s not fun.
Ohh and the pain I feel in my right foot feels certainly different to the pain from PsA inflammation too. More so since my PsA first ignited in this very foot anyway.
Thanks for your thoughts, makes sense. It would be convenient if each type of arthritis presented with a distinct color. RA could be blue, OA, green and PsA would be bright orange. We would only have to stand in front of a mirror and it would be obvious which is acting up! Diagnostics would be certainly easier and group therapy more fun!
2 Likes
Like the color idea…if only. Maybe we could go to the doc and it would glow where the pain is so it would be more easily identifiable as well.
Just a thought - maybe it is still PsA related pain as well - like both ? Xrays may not show all the fun ligament/tendon stuff.
I think most health care professional want to feel successful at what they do and may get exasperated with us frustrating ones that just keep coming back with more problems. But I really hate feeling dismissed as if I am not really feeling what I am feeling. Our Canadian system is so overloaded and our Dr’s stretched very thin that I’m surprised it isn’t worse. They either see less patients more thoroughly or more patients very quickly and factory like. But our condition sometimes can wait but at other times, we need prompt attention. I want to know if I am at a growing risk of permanent joint damage due to PsA. I tend to be very proactive in all areas of my life and think it is reasonable to have ongoing diagnostics performed that tell me where I am at. Pain management is not necessarily disease management.
Unlikely given you take Rinvoq but still always a possibility. The Rinvoq should be decreasing your disease activity sufficiently to prevent PsA damage. Or that’s the goal of all our meds. At the very least it should be lessening the odds.
It can’t however lessen the normal wear and tear OA type issues, or preventing PsA having a party in a joint suffering such wear or tear by twaning tendons and ligaments so having an enthesitis party.
You’re also under some dissillusion that any such diagnostics are capable of being so definitive. They’re not. Sadly. Not at all. Not with our ageing bodies. And not really just anyway. They can PsARC you and do the Leeds Enthesitis score to count issues up but even they’re subjective and dependent on the expertise of the medic performing them.
PsA doesn’t glow orange for us or indeed more importantly glow orange for the medics either.
You’re echoing all my initial frustration when I developed PsA, which was if the science can come up with all these meds for us, why can’t it tell me if x or y is PsA or not? Why can’t it tell me which med is going to work better for each patient? Why can’t we have tailored meds so that any patient’s disease activity and trajectory gets coherently batted away?
It’s only now with rather exciting new research trials are they managing to do far more tailored cancer treatments so that the immune system is now being programmed to only target the cancer cells and not effectively wipe itself out trying to get rid of the cancer cells. So potentially it should be possible to far more effectively minimise the disease activity in the likes of us too. But us lot are way down the list of priorities on this new research.
So if you’re doing ‘better’ on Rinvoq your medics won’t be doing anything to change that. Despite varying other issues. ‘Better’ being wholly subjective too sadly. And often we are simply left with pain management only as well. An increasingly more difficult thing your side of the Atlantic too, given your massive opoid societal problem, which thankfully isn’t as huge here so we’re still prescribed coherent pain meds without too much fuss.
I love breaking it down for patients. As a patient, i know the pain, dismissal from medical professionals, and the lack of communication. As a doctor, I see a lot of OA being called RA just because they have OA and rheumatoid factor. I can validate the pain but explain the differences. I see the opposite too: patient has been in pain since age 30 but is being treated for OA STILL at 60. Or a patient being treated for OA with psoriasis on their elbows that their doctor hasn’t seen. We need to take a closer look!
The poster above explained it well. We don’t always know which joint is affected by which disease. If you’re appropriately treated (biologic + NSAID), it really doesn’t matter though.
Disclaimer: I’m relating to what you experienced and am not providing medical advice.
2 Likes
This, as something of a patient advocate, as in helping patients advocate for themselves, drives me insane. From the point of view of a person whose job it is to follow the ‘evidence’ I wring my hands in despair over how many rheumatologists and GP’s simply refuse to follow the actual evidence!
I’m a bit late to the party but, Amos, you are singing my song! Perhaps we could duet. 
I know EXACTLY how you feel. I started developing OA (I’m told) in my early 30s “because of overly strenuous joint use.” Seriously? I wasn’t a triathlete training for Ironman or anything even remotely like it. I did live off grid on a farm but people 20 years older that had been doing the same work all their lives didn’t have it coming on like I did. So I figured I was just a wuss and told myself to suck it up and get on with life. In retrospect I think it was PsA beginning to knock at my door.
I too have enthesis pain but I’ve given up trying to get anyone to take me seriously when I try to tell them about it. “Yes, this is just wear and tear arthritis.” Which really ticks me off a bit because I know many people much older with less “wear and tear arthritis.” But because my joints don’t seem to be disintegrating I’m summarily dismissed. Or written off as a drama queen. 
Sorry for the little rant there. But I wanted you to know that you aren’t the only one frustrated by pat answers, brush offs and no offered amelioration. Of any kind. And with the aforementioned opioid crisis here in the States it’s nearly impossible to get a pain medication stronger than OTC ibuprofen or naproxen. Both of which, for me, are as useful as a screen door on a submarine. Not that I particularly want an opioid, especially on a regular basis. But it would be good to be able to get something on the odd occasion when chewing off your own limb would be less painful. Thank God they haven’t taken Celebrex away.
Great rant @Mom_Cat! You may have a gift.
I would rather be told by the rheumy or other specialist that they don’t know or are unsure than to write it off as all OA. By being dismissive, they are saying that the meds are 100% successful all the time and that any on going pain is from other causes…which can be true. But knowing our bodies as we do, my OA seems to be pretty constant while the PsA rushes in randomly while completely at rest. My foot pain is very low while walking but when my feet are up and at rest, I’ll suddenly develop weird pain that fades with time. Then a different finger or last night the right shoulder woke me up like I had a knife being pushed into it…the night before it was the left shoulder and one knee. I don’t think that OA is so randomly intense while at rest. Thanks for your thoughts and we might find others to join in the howling song!
The dismissiveness. . . . I had my doctor try to write off my ongoing issues as fibromyalgia. I had to explain to her that multiple trigger fingers was NOT being caused by fibromyalgia. And the fact that my fatigue responds (somewhat) to new meds also implies that it’s caused by inflammation.
I am well aware that it’s not uncommon for people with chronic pain to develop fibromyalgia as well. I don’t have widespread pain though. I have joint pain and tendon pain. Oh, and I’m pretty sure that fibro isn’t what’s causing random bones in my feet to break.
2 Likes
Undiagnosed PsA destroyed both my knees in short order. Two knee replacements. Settled well into my meds for PsA, when I broke my femur, very close to the knee. Surgery (many screws and plates) went fine, and I healed well.
I’ve been noticing a pain (sharp, electric, seemingly unrelated to activity) under one knee. Feels like soft tissue is issuing the pain, since my knee is metal, lol. I’ve told both the surgeon and my rheumatologist- neither seem concerned. Suspect it’s just a PsA giggle fest. Ugh.
As I have become older now 75 almost 76 I feel like I am slowly getting worse. How much is age and I am grateful I am still kicking. How much pain is related to PsA or OA I can’t tell, nor can my primary care doctor or my Rheumatologist. The lack of inability to do what I use means less physical activity and I am sure that also plays a part. Most exercise makes things worse for me, so I have to be very careful to pay attention to how my body reacts and not overdo things. I don’t think we can predict what the future of PSA or OA will be like as we are all a bit different and we all progress or digress at different rates.
My Rheumatologist admits he can’t tell whether it is OA or PsA in my fingers first joints that don’t bend like they use to… Xrays confirm OA in my knees which are very swollen and it looks like I have a cut in half tennis ball on the inside of each knee. I need knee replacements but is is never going to happen because of my breathing difficulties and hypertension. I haven’t had xrays on my hands or most other parts. My shoulders apparently have tendonitis. It all feels much the same sort of pain to me. I have come to accept whatever it is and I do the best that I can to relieve my pain and rest does help me. I have realized that doctors don’t have all the answers. However it did help me to find doctors that I believe are doing the best they can to help me and are not dismissive because it doesn’t show up on a xray or on a blood test. That dismissive attitude does not help and made me feel like they saw me as a winging old cow. I struggled to come to terms with living with PsA, OA and a string of other illnesses but once I did it relieved a lot of stress which can be an important factor in our health
I hope that by sharing some of my situation you can relate to and perhaps it might give you some insight into the answers you are seeking as to whether or not there is a growing risk of you getting worse.
2 Likes
Thanks @bella for taking time to share wisdom and experience and I hope that you are able to stay comfortably involved in life while navigating the years ahead.