Really confused!

So after finding out that this might be the cause of my problems and after doing a bit of research, it seems that there isn’t a test that confirms PsA (someone please correct me if I’m wrong). I have a fibromyalgia diagnosis which is also diagnosed with no specific tests. So, how can they tell the difference and how will they know whether it’s PsA or fibro that’s causing my pain?

Inflammation. That’s the big difference. Fibromyalgia doesn’t have an inflammatory component. Psoriatic arthritis does. And of course, there is the skin component as well.

Ah ok, I must have misunderstood that there was no test and it was a process of ruling out everything else! Thanks, that makes more sense!

I suppose the problem now lies in finding evidence of inflammation. I get very confused about just what various forms of imaging - MRI, ultrasound, x-rays can show and what they can’t. I am pretty sure that ultrasound can show inflammation though it may not always be quite that simple.

I’ve never had imaging to look for inflammation but as it happens I have shown raised inflammatory markers in blood tests, not everyone with PsA does. If ESR or CRP are raised that can be an indication of an inflammatory disease such as PsA rather than fibro. Have you had blood tests to check for inflammation? This is something that GPs can do.

Another thing that shows inflamed joints is swelling, joints can be affected by PsA without swelling noticeably but swollen / tender joints really help with diagnosis. The finger joint you showed us definitely is swollen isn’t it? But a hard swelling there could easily be osteoarthritis too (which is not an inflammatory disease although it causes localised inflammation - welcome to our world!), so you do need a rheumy’s view. Do you have any other swollen joints?

There’s also the possibility of fibro plus PsA, for some reason that seems to happen a lot. I have a family member who has really bad fibro and I know how devastating it can be in some cases.

It’s often said here that pain alone is not a great indicator of disease activity and I guess you could also say that it is not a good indicator of different types of disease either. There is a Ben’s Friends fibro community and I’m just wondering whether you might want to join them too (don’t leave us!) to chew over whether some of your alleged fibro symptoms tally with others’ experience or not.

All in all though, as you have psoriasis plus joint pain you really need and deserve to be checked out by a rheumatologist. Those two things alone suggest the possibility of PsA I am sure.


There is no blood test. The diagnosis of PsA is done entirely on clinical evidence (what the doctor can see). One of the things that get rheumatologists sleuthing on the wrong path is that PsA, unlike other inflammatory diseases, doesn’t always push the inflammatory markers up out of the normal range. Something like half of PsA-ers have inflammation markers in the normal range. So if a rheumatologist sees a normal blood test for inflammation, and it’s normal, they might just think "Well it’s not an inflammatory arthritis, so let’s see … hmmm…I know! Fibromyalgia.

There are, though, well-established criteria for PsA. You may find this (click on that) interesting. How would you score yourself?

It just bothers me when they diagnose it as fibro because I’d say from how I’ve heard fibro described I swear a lot of my PsA had fibro symptoms. I had weak muscles, sore tissues–yes, the skin on my upper legs and forearms was “sore”–I always thought maybe psoriasis “hid” under the top layer of skin, which, to me, seems possible. BECAUSE, when I went on Enbrel that soreness, tenderness, or whatever you want to call it, went away! My PsA pain definitely wasn’t just my joints, it seemed almost to take over my entire body. So, you can tell your doctor that you know people who have been diagnosed with PsA and treated with a biologic that works for all the symptoms that some would say were fibro. If you have ANY psoriasis or nail deformities–or close relatives with psoriasis–and you think this is more than fibro, keep talking to your doctor and pushing for answers. My blood tests don’t show any inflammation. It’s so frustrating to hear of people with symptoms that can maybe be relieved with a biologic, but the rheumy won’t make the diagnosis of PsA!

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Yeah, I had the “sore all over” too. I ached from the waist down. I had muscle cramping and sore shins. My shoulders and upper arms ached. My arms felt soooo heavy. Yes, my knees were painful, but I know now that what I was feeling was inflammation of tendons etc. And yes, when they finally found treatment that worked for me, that pain disappeared like snow in the sun.

When the diagnosis makes sense to you, and you understand the treatment plan, that is when you can start looking forward to feeling better. Persist!


I also get sore shins and aching legs. I never connected this with PsA!


Oh, isn’t that interesting! I remember the days when I would go to bed and be unable to sleep because my body was soooo sore from the waist right down into the arches of my feet. Oddly, I found the most effective medication not to be acetaminophen or anything like that, but a muscle relaxant. My theory on that is that inflamed tendons made the muscles tight and crampy and painful. (But what do I know?)

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Funny thing is, Seenie, you know, I know, and a lot of sufferers who get good results from a biologic know probably more than most medical “experts” know because WE know exactly what PsA feels like! A pulmonologist who diagnosed me with asthma years ago told me too many doctors go strictly by what’s in the textbooks and, unfortunately, everything isn’t always written in the textbooks. Too bad every newbie seeking a diagnosis can’t go before a panel of us PsA EXPERTS because our diagnosis would be spot on pronto!


I have to say I sometimes get in the “but how do they know?” frame of mind when I’m told something by the doctor and yet there’s no test for it. I was like it when PsA was diagnosed (although I did have inflammation in blood tests), and now I get like it when I describe a new symptom and everything is put down to PsA. I’m thinking that I realise it could be - but then it might be something different. I guess we just have to trust as best as we can - both the doctors…and our instincts!

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darinfan you should try going through the menopause LOL! In that situation every damn thing is blamed on ‘The Change’. Like many I blamed all my PsA symptoms on the menopause and since then I don’t trust my own instincts one iota. Lately there have been so many thoughtful, detailed histories here from ‘newbies’ and each one I read makes me reflect on my own sorry PsA story … more and more convinced it goes back to adolescence which is now ancient history. I don’t really need docs to fail me, I do it quite adequately myself … even at 16 I thought that dragging myself through the day was probably due to being a teenager. Not sure how I rationalised waking with locked knees in my 30s …

Grandma_J I mostly agree with you, but I think we need to be a little cautious when people may have PsA because there are other forms of inflammatory arthritis and some days I think the dog has PsA, or the postman says he’s feeling tired and I have to resist giving him the PsA inquisition, that’s sort of how it is when you’re living with a condition like this. Much as we know the signs inside out, I still think nothing beats the clinical judgement of a really good, ‘PsA-aware’ rheumatologist.

Which reminds me, Picklepudding, not asking you to say where you live online, but would you like recommendations for UK rheumys? I’ve got the Welsh Borders and East Kent covered, then there’s the Bath and Leeds centres of excellence for PsA. And other Brits here may be able to contribute more.

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I’m so frustrated at the possibility of having another condition that can’t be categorically proved one way or the other…I also have fibromyalgia and lipoedema (plus other health conditions) and neither of those can be definitively diagnosed with any tests. Very frustrating. I haven’t yet plucked the courage to visit the GP, worried that I’ll sound like Dr Google!

Sybil, you made me LOL 3 X. My husband looks at me like I’m nuts when I do that!
You’re right, though, I also tend to put the diagnosis on everybody (especially our kids and grandkids) when they have any dry skin or fatigue!
This discussion reminded me also, though, that when I had shoulder pain for a couple weeks prior to my coronary artery blockage which was a symptom of THAT, I kept thinking it was PsA pain in my shoulders! Now I’m so confused about any pain I get in my shoulders, chest, arms or hands–wondering if I should report it to my cardiologist or just write it off as PsA pain!!! I’ve been worrying more and more about this! The cardiologist will write me off as neurotic if I message him e/o day about my weird aches and pains in the upper quarter of my body!!! :flushed:

Picklepudding, I know exactly how you feel re. GP. However … there’s Dr Google and then there’s Dr Google … This is what Arthritis Research UK (a very well respected body both off & on the internet), has to say:

“The National Institute for Health and Care Excellence (NICE) published new quality standards in 2013 to help improve the care of people across England with psoriasis.
The standards are mainly aimed at GPs and state that people with psoriasis should be offered an appointment every year to check for signs of psoriatic arthritis and every five years to check their cardiovascular health. This should help in diagnosing psoriatic arthritis as early as possible and making sure that the right treatment is started.”

Whether psoriasis has been or is mild is not relevant to the risk of PsA. You are surely one of the people NICE were thinking of, plus you have joint issues. If your GP doesn’t take you seriously, that will not be your fault. You would then need another GP. But that’s a worst case scenario. You are being very reasonable, not some internet addict.

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I can imagine how frustrated and overwhelmed you feel. But if you have concerns about perhaps having PsA, you really need to see a good rheumatologist. You do not want to be adding joint damage to your list of health problems.
That said, I have to agree with you about not wanting to sound like Dr. Google. :blush: