PsA without inflamation?

Hi Tim 

you are showing all the signs of classic Arthritis but there are different form of it as you are aware. It took my GP two years to finally refer me to a specialist who diagnosed it as Psoratic Arthritis. My bloods show an increase in inflamation in the results and have gone from 20 when first diagnosed up to 32 at present even with medication but it can be a long road to finding the correct medication(s) for the individual. I really not sure what to suggest if the specialist is ruling PsA out apart from getting a second opinion. Some medications such as Ibrupen can cause problems with hearing. I am now 51 and my symptons starting showing over two years ago but not picked up on by my health proffessionals despite going back often with the same or different symptoms that all pointed to PsA so they can make mistakes and miss the real diagnoses. Personally i would keep a record of the pain and keep going to the GP for tests it was not until recently that i could see the inflamation in my joints but all the signs were there as the disease was attacking the joints with no physical signs but since it has show signs it got worse very quickly as the disease really took hold. There is proof that if caught within the first six months that a lot of damage to joints can be drastically reduced if treated correctly and blasted with high doses to stop or slow down its effects on the joints. 

hope this helps 

Rob 

Hi Tim,

sounds like PsA to me. Particularly when you mention nails. Keep a diary, including photographs and ask for a 2nd opinion. Good luck. Sheila

Tim, your situation is almost identical to mine! I'm 47 and have been having strange symptoms for 15-20 years, including a sudden inflammation of my knee (around 2001) and itchy red patches on my skin that got brushed off as pityriasis rosea (1998), but was probably the first sign of psoriasis. And all through this time, I had increasing discomfort in my left sacroiliac joint and left knee and left foot. As in your case, X-rays and blood tests never showed much if any inflammation.

Finally in 2014, the sacroiliac situation became severe, and that was followed by a big flare up of psoriasis and my doctor diagnosed it as PsA.

He says one of the reasons for the lack of visible inflammation is that it's my tendons that are inflamed, not so much the joints themselves. It sounds like this is your case too. The rheumatic factor in your blood (the "deposits" they look for) are not a prerequisite for a PsA diagnosis, as far as I understand.

I have never experienced the chest pains you describe, but interestingly, my brother has and his doctor says it's a rheumatic condition, so probably not surprising in your case.

I also know the burning sensation you describe, also on top of my foot; I get dizzy on standing (my blood pressure tends to be low); have occasional tinnitus and have experienced the deterioration of my toenails (thankfully not my fingernails, yet) that you describe.

I find it strange your doctor is not treating this as psoriatic arthritis. That said, my treatment (methotrexate + anti-inflammatory drug) has not been all that effective, but there is some relief available. The anti-inflammatory was especially effective on the crippling sacroiliac discomfort.

It's terrible to feel this is all "in your head." It's not.

Good luck getting your condition diagnosed and treated properly.

Tim how awful for you

I have PsA and as for the psoriasis part of it the only things I have to back that up are nails which are ridged and lift from the base and sausage fingers and toes. I nearly got diagnosed with RA as when I got the info back from my first visit with the rheumy I noticed in his notes that he had said no visible ridging in nails etc which I immediately wrote back to him and said he hadn't seen my nails and I had nail varnish on! On the second visit I was examined more thoroughly and diagnosed with PsA. I would go back and explain these symptoms which seem obvious to me and also get bloods done again. My inflammatory markers go up and down all the time so maybe you weren't having an 'attack'. It is sad but we have to fight for treatment in this field. Don't give up. Never stop smiling and in the meantime I find ice packs the best relief for pain. Good luck

Lisa 😊

Hi Tim I have had almost identical symptoms that you describe but for years no one put all of it together - I have been hospitalised twice with chest pain but discharged after 24 hours cause there was nothing wrong with my heart - thank goodness.  Three times now I have wakened up unable to get out of bed because every joint in my body hurt so much but again nothing in my blood work indicated rheumatoid arthritis so I kept it till it got better!!!  I was referred to rheumatology with suspected OA but after injections into my knee the consultant was going to discharge me as there was nothing else to be done - it was only when I mentioned I had tendonitis that she asked me if I had ever had psoriasis and I said yes in my 20's - she then said that expained the odd blood work results they had been getting and I was diagnosed with PA.  but here is the thing I have never been put in medication - just told to come back if I felt I needed another injection.  Since then I have had problems with my ankles, fingers toes shoulders as well as my knees.  Also had the yellowing of finger and toe nails.

Hi again Tim

the inflammatory marker blood test for RA is either positive or negative. Even 20% of folk with RA have a negative reading. This group of people with the negative blood marker are referred to seronegative arthritis, of which PsA is one. The difficulty in diagnosing this is there is no one simple test! But a selection of some of the following usually leads to a diagnosis:

Psoriasis usually (but not always precedes PsA, usually 5-10yr)

sausage toes and fingers

pitting, yellowing and lifting of nails

fatigue

stiffness, particularly am

swelling and pain, any joint, usually mirrored on the other side

this is not a complete list, look at PAPAA or Arthritis Research websites for more info.

finally, getting that 2nd opinion. Early treatment is needed to limit joint damage. Let us know how you getting on. Sheila x