What labwork or assessments does your Dr use?

Hi, guys,

I'm a PSA patient and I get frustrated that our disease is one of exclusion: RA has a factor to track in labs and Gout can be tracked by uric acid levels. If I did not constantly point out my painful and tender joints, I'm not sure my docs would understand where I am with this disease (read: not in remission).

Other that the sed rate (and watching Hepatic levels due to MTX), what are some of the diagnostic tests your doc monitors? There may be a test that my team is overlooking and that I can ask about.

There is a genetic marker that is sometimes present but I have not heard of anyone getting that test: HLA-B27. http://www.spondylitis.org/about/psoriatic.aspx

I have not had x rays but would like to as my hands are very involved and feet to a lesser extent.



To put it succinctly any rheumy who is determines your treatment based on lab tests after a diagnoses has been made should have never passed his boards. The CasPar (or a version of it) is the generally used by by most practices. Its a little form you fill out at the start of every appointment it is then scored and plotted with your other forms. Doesn't matter whats hurting today if the scaled score doesn't change. The CasPar is extraordinarily accurate.

Inflammatory spinal pain, tendinitis, enthesitis, or dactylitis being the primary issues, There are few if any imaging studies that will identify these issues. Iknow how cool it would be to do a stick and have that determine the treatment. Doesn't happen.

HLA-B27 testing is complete waste of money While it is a genetic marker presence of it means nothing (most people with it don't have any disease). They have pretty much quit running the test as there are over 30 other genetic markers. Besides if you have psoriasis, you have fulfilled the genetic requirement.

With any chronic disease all you can treat are the symptoms. For the most part lab work is either positive or negative (unless monitoring chemistry) With any chronic disease they symptoms don't go away (usually.

Incidentally the RA factor is only 30% accurate FWIW the SAA site is prolly only exceeded in poor quality and inconsistency by the Arthritis association. Their boards are horrible. The misinformation being flung about is scary.

When I was being diagnosed, I was RA negative and ANA negative. I already had erosions in my feet, but my CRP and Sed rate had never been anything except very slightly elevated. My PCP thought it was my excess poundage that caused that. When my hip needed replacing, the x-rays looked like OA, and my inflammation markers were slightly raised, but nothing alarming. When they opened me up, the inflammation was extreme – clearly PsA, not OA.

Do you have the book I recommend under Book Reviews? According to Gladman and Chandran, less than 50% of PsA patients have elevated CRP and ESR. I guess that would be me! No wonder this disease is so hard to diagnose, and why so many of us went through a period of thinking it was all in our heads.

Gladman and Chandran also point out that, to date, there is no diagnostic lab test for PsA. X-rays don’t show inflammation, only damage, so if there’s no damage (yet) the x-ray’s not going to be much help. Even when there is damage, it’s sometimes hard to distinguish between erosive (PsA) damage, and ordinary wear-and-tear.

G&C also mention that the HLA-B27 genetic test isn’t routinely done. Only about 20% of PsA patients are positive, so that doesn’t narrow it much down either.

So I guess that leaves manually assessing your finger and toe joints, and anecdotal reports of pain.

Now on MTX and Enbrel, I go for monthly blood draws. I get a complete blood count, as well as liver panel.

I have had regular x-rays to track disease progression in my hips and feet, in addition to a foot MRI and a nuclear bone scan. (My knees were already has-beens before I was diagnosed.) I recently had a CT scan of my feet to assess the degree of PsA damage.

What an affliction! But you knew that already … LOL

Summary –
Lamb’s right: neither the diagnosis nor the treatment of this disease can be guided by lab tests.

I was negative for the HLA-B27, my RA factor was slightly elevated and everything else was normal but based on the history I gave my Rheumy thought I had had PsA for at least 30 years when I was diagnosed 6 years ago. The MRIs showed a lot of damage in my spine, scoliosis and herniated disks but not why it happened. Both could have been caused by PsA or other reasons. I told my Rheumy I might have been born with scoliosis, she stated it might have been the PsA. My Rheumy checks my hands and feet at every visit and sometimes tries to check the range of motion of my hips. I think she makes an assessment on the rest of my joints based on the joints she can easily see. I haven't really had much blood work (other than hematocrit and liver enzymes) since I was diagnosed. I have had hand films done by the ortho hand guy so he could inject for trigger finger but not for assessing damage. I think my Rheumy is assessing my inflammation by what she can see and feel and what I report. I wish there was a test but there does not seem to be.