Question/ Discussion

I am posting after a really long time. Just been busy with life. I just wanted to give quick recap. My wife has PsA. She was taking Humira but got tuberculosis so she stopped. She completed long treatment for 18 months successfully and few months into the treatment doctor was okay starting her on methotrexate. So she is taking methotrexate for close to 3 years now.

Recently she is having pain in her left hand finger. But only in one finger. It’s swollen too. So you can clearly see the inflammation. So her recent visit with rheumy he (doctor) was little confused why the pain is only in one finger. And then he started thinking out loudly saying arthritis pain shouldn’t be in only one finger. And he mentioned few other things while thinking out loudly. But one thing kind of stuck with us when he said Bone tuberculosis. And that is stressing us out. What are the chances of her getting Tb back even after completion of treatment and just on Mtx. Also for PsA do you always need to have pain in multiple joints?

Sorry just wanted vent and seek some opinion from the forum

I know nothing about tuberculosis but I DO know that PsA is something that isn’t bilateral. I found out I had PsA because my right knee felt like I was having labor pains in it…
So, in my opinion, because I ‘got’ a PsA sausage little finger, it isn’t unusual at all. In fact isn’t that one of the signs of PsA???
That’s all I got for now.

I’m sorry that you and your wife are dealing with this. My first question is didn’t they do a TB test before she got onto the biologic? Or she was exposed after starting treatment. Either way, it happened, so she’s dealing with it.

Psoriatic arthritis can be unilateral OR bilateral. I tend to be bilateral, my mom tends to be as well. One swollen finger. . . . Not impossible to be PsA. I started off with one swollen finger and that led to diagnosis. So let’s look at the worst case scenario, that it is bone tuberculosis. How does that get diagnosed or ruled out? Is there non-invasive testing that would point in one direction or the other?

Like the others, sorry I can’t help on the TB question - that must be very worrying.

As far as PsA, my first sign was just one elbow. Then months later, just one knee. Then my lower back, then all of a sudden bilateral all over the place. I have a friend with RA in just one finger. And I’m thinking that if it is generally well-controlled, it is quite possible for a flare in just one joint. But what is probably more relevant is how she has had previous flares? Has she ever had just a few (or one), non-symmetrical joints? If so I really wouldn’t be jumping to any conclusions on the TB, but would be doing whatever scans should be able to see it. If she has always had multiple, symmetric joint involvement, I still wouldn’t be jumping to conclusions, I’d just make sure the TB checks were done in good time, and remember it is not impossible for osteoarthritis to settle into one joint, and PsA often seems to accelerate it.

I often have one joint give trouble. I started with persistent ankle/heel pain, then one knee, then both. I have one knuckle on one hand get very painful and the same finger on the other hand have little pain but more swelling. PsA has a mind of its own and just when you have it figured out, a sneak attack occurs!

PsA can very much be in one place for a time. Depending on the level of your PsA activity it can just stay in one place for a long time. Or if if wants it can move off to another just one place or fire up several different places.

What seems most probably is that the mxt your wife is doing a decent enough job to keep PsA symptoms to just one place for now. But the fact it’s there at all should be making your rheumy think of adding in another DMARD.

I’m concerned at your rheumy’s thought processes on saying ‘this can’t be PsA’ when it certainly can be. And I’m concerned he’s raised the TB issue again out loud scareing you both so, after such a previous big TB treatment for so long.

My advice - go back and ask him what on earth is he thinking when PsA presents like this in patients all over the world?!

Thank you all for the responses. I think general consensus is PsA can be in single joint. During next appointment with rheumy I will ask some follow up questions.

TB thing was just unfortunate, we tested before starting Humira and did INH Therapy before starting Humira. But since tb was drug resistant the INH treatment didn’t work and it became active. Since than we are very reluctant to start biologics since no doctor (rheumy or infectious disease) is giving us a confident reply when we ask about chances of reactivation if we start biologics again. So we are just managing her PsA thru MTX right now.

I can be only on one side. I wish I was that lucky