Other pains?

Hi all. When being diagnosed with PsA 9 months ago, I initially had X-rays done on my problem spots- hands, feet and knees. Because they didn’t show PsA, my diagnosis was then made with an MRI of my most problematic area(hand)which showed some erosions. Noe, back to the X-ray. Per X-ray, my knees have some degenerative damage and loss of some cartilage. I pretty much knew that because my knees grind when I extend them out and I went thru PT and an orthopedist when I was about 24 (am 36 now). Well, all of the sudden, and coincidentally since starting Mtx, my shoulders have the same grinding going on. Never had a problem before and bam, both of them are in pain and grinding. So, my question is, how do you tell if you are having pain from PsA, Mtx or its something else? I mentioned it to my fil-in rheumy ( mine is on maternity leave) and he didn’t have much to say. I really don’t want to think that, when living with PsA, every pain you experience will be chalked up to PsA and you will be sent on your way. Do I go to an orthopedic doctor? Push for X-rays? I am having a hard time separating this disease, meds and new pains from one another. And basically, I just don’t feel good. Thanks!

One of the things I noticed after going on PsA meds is that when my inflammation was decreased by the meds, the grinding of joints got worse and I had issues in places I hadn't before. Both my rheumy and my massage therapist pointed out that the inflammation and build up of fluid from the PsA probably cushioned the joints a bit from the grinding. When diagnosed, my PsA was worst in my ankles, knees, hips, and back. After treatment, the issues are more with my shoulders, wrists, and hands.

It definitely a challenge trying to figure out what pain/discomfort/etc. is from what.

I have some osteoarthritis on top of the PsA. But here is my general guideline. I go to my rheumy for overall disease treatment and management. I keep her up to date on all of my bad spots, and if something goes downhill fast, I make an extra appointment. This would include sudden swelling, but I do a lot of management issues on my own

I go the orthopedist when it is clear that I need to strengthen up joints, and may need x-rays to diagnose a specific problem. As an example. My hip started hurting me about 6 or 7 months ago. When I saw my rheumy, I let her know, and she looked at range of motion. I also told her that it felt more like possible osteo, as it was worse after movement, and I had a hip flare from PsA a few years ago. This is different. So I made an appt with the orthopedist to get x-rays, and try to figure things out. Beginning of osteo, and I was sent off to physical therapy to strengthen and stabilize.

I hope this helps. I was diagnosed almost 6 years ago, so I've (sortof) found my own guidelines of how long I feel comfortable treating on my own before being seen. This is something you will work out with your own doctor over time, including medication options for a flare.