I have had a few positive things happen since on Enbrel and am now trying to find out if someone here knows (we have such a wide and educated group here) if PsA sometimes targets an area that is already compromised by injury/stress and then the PsA becomes the major problem instead of the original injury.
I had broken my ankle in 1983 and balance has always been iffy since and had gotten worse over time. My foot began to not be able to be put flat on the floor - it would roll out to the outside part of the foot. Not only was this painful but the knee took on a tremendous strain to do the balancing job the ankle was supposed to do. Physical therapy had minimal impact. Then, when I switched from Humira to Enbrel after 2 1/2 weeks I began to be able to put the foot flat down on the floor. This area continued to improve but the knee began to be very stressed and painful as it had to now adjust again and this time to return to more normal alignment. I have used a knee brace and more physical therapy. My knee is much better now but not 100% yet (but very very encouraging).
So my question is: did the PsA maybe settle in my foot/ankle due to the original injury there and did it mayb e also reside in the knee due to the strain on it (of course the mere strain to the knee was rather extreme and can be the sole reason for the pain). Does anyone know or run across information suggesting that some PsA locations favor old injuries ?
I have the same thing. When it happens to the skin, psoriasis appearing where injury has happened it is called Koebner Effect. For me it happens mostly with friction injury such as where my rings rub but can really happen anywhere on my skin. When it happens in joints, tendons, ligaments etc. it is referred to as Deep Koebner Effect. If you google it you can read all about it. My Rheumy says a lot of my joints seem to do it. When I respond well to a biologic it seems to settle down and I stop driving with a bent foot! Which is much safer for us all!
Thank you very much for the infor. on deep Koebner Effect. I did google it and there is not a lot on it but what there is seems to be a match for my issue. besides the ankle and knee issues noted in my opener posting I also have had a variety of back problems since in grade school and an additional injury to my back as an adult - and the pain kept getting worse until I started on MTX and a biologic and found significant relief for my back. So again - old injury and apparent site of PsA.
michael in vermont said:
I have the same thing. When it happens to the skin, psoriasis appearing where injury has happened it is called Koebner Effect. For me it happens mostly with friction injury such as where my rings rub but can really happen anywhere on my skin. When it happens in joints, tendons, ligaments etc. it is referred to as Deep Koebner Effect. If you google it you can read all about it. My Rheumy says a lot of my joints seem to do it. When I respond well to a biologic it seems to settle down and I stop driving with a bent foot! Which is much safer for us all!
If I hurt myself (bang a knee or hurt my hand), I will have inflammation settle into the area for months. I really have to protect my joints from casual injury. Obviously, I can't do anything about a serious injury that might happen, like a broken foot! I'm not surprised you have PsA settle into a previously injured area.
Oh boy! I recently fell and sprained an ankle, but didn't break it. That is the ankle that always had a little swelling due to the arthritis, even with biologics which are a miracle. I thought that it would probably not fully recover, so now I am planning on that. My dad had psoriasis on his skin badly, and he often developed it where he had injured the skin, such as a bad burn. I figured that the psoriatic arthritis was the same. Thanks for the information.
You enjoy reading it as it has great photos to show what they are talking about. The take away though is way at the bottom (#5)The law of parsimony. Basically its your explanation - simply more than one thing can happen in a joint.
John D. Reveille MD is pretty much considered the GURU of all things spondyloarthropathy which is the family name for PsA. The way he has explaineded it a number of times Is the spondyloarthropathy one has is NOT the arthritis )in our case its PsA) but rather what causes the arthritis. We know arthritis like to get roaring in place where there has been injury. It seems to me to be reasonable if we have PsA that is more likley to happen. I know thi is pretty basic but there are a couple of great take aways:
In my case it almost lead to some real problems. I used to jump out of airplanes for a living. None of those fancy chutes for soft landings like today. if you didn't roll right when you landed you got hurt (as there were sometime folks shooting at you as you came down you had a lot of incentive to get down fast and to land right) None the less I had a number of hard landings. So when my spondylitis started in my early 20's, I assumed that was it and ignored it. When I broke my back in a few places in my 40's I was sure again that was it. Now trust me I should have known better....... Anyway its a cart and horse.
Marc, one current pet theory of mine is that PsA means that something that would have been at worst a minor nuisance pre-PsA now becomes a real problem. For example, I've had some pain & stiffness in my hips, but nothing I couldn't ignore. A few days ago I took a false step while out with the doggie, and now one hip has been just plain awful for days-way out of line with the lack of severity of the incident.
Your knee, for example, might have been OK if it was healthy to start with. If PsA was already messing with it though, even if you weren't aware of it, walking funny could have thrown it over the cliff, so to speak. Cart and horse, as Lamb said above.
Much thanks to all with your postings and links. You have all helped in answering my questions and supports my proper read of things and the ugly implications for the future in injured areas.