Reactive PSA?

General
1

Hi, Im trying to figure out whats going on with me. I was diagnosed with P and PSA in 1985. Its always been mild. Ive used creams for skin and ibuprofin for arthritis, mainly in hands and feet and upper spine. Again its been mild for 20 or so years.

About a year ago it started to get worse. Felt more like connective tissue pain. Entire rib cage, sternum, shoulders, neck and tendons in hips. Some times I feel it in joints but mainly in tendons of hips. It can be unbearable.

Now the strange thing is that it seems to be connected to certain foods. An example is bell peppers. They make it all worse. By avoiding certain foods doesnt make it go away just not as severe.

I recently went to a rheumatologist. Im trying methotrexate. Been on it for 2 months. Seems to help somewhat but when it flares up it feels worse than ever.

I go see the rheumy again in a few days to say the metho isnt working and to discuss options. Maybe biologics?

Does anyone else share these symptoms? If so what works? Is there such a thing as reactive PSA? Or maybe its something else all together?

2

So some of the questions, including diagnostic ones, you'll need to talk over with your rheumy. Bring a good list of questions and possibly a second set of ears with you.

There has been some discussion and research showing that MTX does not work for PsA, although it seems to be a favorite of rheumies. I can't remember the article exactly, but you can search on the site for this. It may work well in conjunction with some of the biologics, but on it's own, it doesn't seem to be proven for PsA.

Diet. . . Again, some people find that their symptoms are definitely related to food. Bell peppers are in the nightshade family, and that seems to be a common type of food that is a problem for many with inflammatory problems. I've tried out dietary changes for myself, and haven't noticed any change in symptoms, but don't let that stop you. Some people are more sensitive than others in this area.

You said that about a year ago it started getting worse, and felt like connective tissues. YES! Tendon issues of a few different types are very common with PsA. It may be enthesitis (sp), tenosynovitis, tendonitis, etc. For some, this may be the most painful part of the disease. Joint destruction can be less painful, which is why it is so important to treat aggressively, to avoid joint destruction.

Just so you know, in terms of alternatives to MTX, there is another drug in this class, called leflunomide (brand name Arava). This seems to have much better evidence supporting it's use in PsA. Like any drug, there can be side effects. One possible concern with leflunomide is the very long half life, and if you are planning on having children, this is something to talk to your rheumy about. There is also plaquenil, which seems to be more of a starting point for some, but not all. That particular one happened to be safe for breastfeeding moms, which is why I was initially started on that.

Good luck with your appointment! Keep us up to date.

3

PsA is an inflammatory arthritis that waxes and wanes so it could "feel" like a reactive arthritis but it really is inflammatory in nature. Some people seem to flare with weather and food so it can really seem reactive. My trick is to take a pocket calender to the doctor with my pain and stiffness documented and questions I mean to ask. Good luck and be sure to let us know.

4

I often wonder if I wasn't misdiagnosed with PsA. I often think that perhaps I had/have Reactive Arthritis instead. I know that Reactive Arthritis can be extremely painful at first but usually becomes mild with time and often disappears on it's own. Well, that's exactly what my PsA has done. In the beginning (1998) I was devastated by arthritis. Hands, feet, knees, elbows, shoulder, and even my jaw was affected. I wasn't even sure I was willing to live with such a disease. So I went thru the meds (MTX, Sulfa, Humira, NSAIDS, prednisone and Remicade) and was okayish for several years.

Then after I had a reaction to Remicade last year I decided to forego the meds for as long as possible. Well much to my surprise not only did my PsA get better, it TOTALLY went away. I'm currently 9 months med free and have zero signs of PsA (except for P lol). So I dunno. maybe I'm just one of the extremely lucky one's or perhaps I was misdiagnosed.

5

Hi, Thanks for your replies.


I had my rheumy appt yesterday. He wants me to try the methotrexate for 2 more months. It does help with inflammation a bit but it will have to work alot better for me to not try biologics. My Doc said in two more months that well consider biologics. Is trying mtx for 3 to 4 months normal? Im thinking maybe insurance wants a few months try and fail before biologics.


I also have Friedreichs ataxia (FA), a genetic neurological condition. I use a wheelchair about 80% and walker 20%. Its the reason my doc is so apprehensive about me trying the biologicss, but Ill try anything to deal with this pain.
He also told me biologics have alot more siide affects than mtx. Is that really true? Ive read conflicting opinions.

6

I have found that when I have questions about my meds I go to my pharmacist. I also have found some drug reps at my children's school. It is through my interpretation that MTX has more servere side effects but we have to remember that we are only taking a little of the medicine at a time. The studies are on patients that have taken large I mean huge amounts of this drug for cancer treatments.

What I am finding for myself is that the Enbrel has kicked in and we are going to start weaning myself of the MTX to see if I can go without it. The only way we will know if we need both is to try it. Also, it has been documented that MTX is not affected for PsA.


With this condition, we have to wait and see what happens (try many combination of medicines for not every one reacts the same) and this is hard when we are a generation where we expect instant gratification.