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Understanding Psoriatic Arthritis
As you may know, it's not uncommon for people with autoimmune disorders to have other concurrent conditions (known as "co-morbid" conditions, a term I do not personally like). About 30% of psoriasis patients also have a form of arthritis called "psoriatic arthritis, or "PSA" in our community. Psoriasis alone (typically occurs between ages 15 and 25) usually precedes arthritis (the typical onset between ages 30 and 50) for those patients with both. In most cases, a patient with psoriasis will start to notice difficulties with their joints as well as their skin. Since there is no blood test to confirm PSA, rheumatologists can confirm the diagnosis based on visual examination of the patient and elimination of other diagnoses.
PSA can affect joints in the fingers, the neck and lower back, wrists, and knees or ankles. There are five types of psoriatic arthritis: symmetric, asymmetric, distal interphalangeal predominant (DIP), spondylitis and arthritis mutilans.
Fortunately, a number of treatments for psoriasis can be effective in managing the arthritis as well. Many patients have experienced some pain relief when using corticosteroid ointments, although prolonged use can lead to thinning of the skin. Some of the long-time available systemic drugs, such as methotrexate and sulfasalazine, have proven to be effective for both diseases. Within the past decade, certain biologic drugs (infusible or injectable) have been introduced which are used for the treatment of both conditions. These include: Enbrel, Remicade, Humira and Symponi.
Further information about diagnosis and treatment, including a description of contraindications and side effects can be found at the website of the National Psoriasis Foundation, http://www.psoriasis.org/netcommunity/psoriatic_arthritis .
Do you have psoriatic arthritis? Please let me know your age when you realized you had it, the severity of the psoriasis and the PSA separately. What treatments have worked well for you? Are there any treatments that haven't?
[br>
PSA can affect joints in the fingers, the neck and lower back, wrists, and knees or ankles. There are five types of psoriatic arthritis: symmetric, asymmetric, distal interphalangeal predominant (DIP), spondylitis and arthritis mutilans.
Fortunately, a number of treatments for psoriasis can be effective in managing the arthritis as well. Many patients have experienced some pain relief when using corticosteroid ointments, although prolonged use can lead to thinning of the skin. Some of the long-time available systemic drugs, such as methotrexate and sulfasalazine, have proven to be effective for both diseases. Within the past decade, certain biologic drugs (infusible or injectable) have been introduced which are used for the treatment of both conditions. These include: Enbrel, Remicade, Humira and Symponi.
Further information about diagnosis and treatment, including a description of contraindications and side effects can be found at the website of the National Psoriasis Foundation, http://www.psoriasis.org/netcommunity/psoriatic_arthritis .
Do you have psoriatic arthritis? Please let me know your age when you realized you had it, the severity of the psoriasis and the PSA separately. What treatments have worked well for you? Are there any treatments that haven't?
[br>
27 Replies |Watch This Discussion | Report This| Share this:Understanding Psoriatic ArthritisAs you may know, it's not uncommon for people<b> </b>with autoimmune disorders to have other concurrent conditions (known as "co-morbid" conditions, a term I do not personally like). About 30% of psoriasis patients also have a form of arthritis called "psoriatic arthritis, or "PSA" in our community. Psoriasis alone (typically occurs between ages 15 and 25) usually precedes arthritis (the typical onset between ages 30 and 50) for those patients with both. In most cases, a patient with psoriasis will start to notice difficulties with their joints as well as their skin. Since there is no blood test to confirm PSA, rheumatologists can confirm the diagnosis based on visual examination of the patient and elimination of other diagnoses. <br />PSA can affect joints in the fingers, the neck and lower back, wrists, and knees or ankles. There are five types of psoriatic arthritis: symmetric, asymmetric, distal interphalangeal predominant (DIP), spondylitis and arthritis mutilans. <br />Fortunately, a number of treatments for psoriasis can be effective in managing the arthritis as well. Many patients have experienced some pain relief when using corticosteroid ointments, although prolonged use can lead to thinning of the skin. Some of the long-time available systemic drugs, such as methotrexate and sulfasalazine, have proven to be effective for both diseases. Within the past decade, certain biologic drugs (infusible or injectable) have been introduced which are used for the treatment of both conditions. These include: Enbrel, Remicade, Humira and Symponi. <br />Further information about diagnosis and treatment, including a description of contraindications and side effects can be found at the website of the National Psoriasis Foundation, <a rel="nofollow" href="http://www.psoriasis.org/netcommunity/psoriatic_arthritis">http://www.psoriasis.org/netcommunity/psoriatic_arthritis</a> .<br />Do you have psoriatic arthritis? Please let me know your age when you realized you had it, the severity of the psoriasis and the PSA separately. What treatments have worked well for you? Are there any treatments that haven't?<br />[br>
marshallal responded:
I was diagnosed with psa at the age of 38, moderate to severe psoriasis and moderate psa. I currently take methotrexate injects weekly and remicade once a month. Remicade started out wonderfully cleared the skin up and pain free joints but now after 5 years it only helps with the joints for a couple of weeks and my legs from the knees down are almost completely covered. I have tried many treatments for the skin but found that for me the best treatment is clobetsol with Xclair cream keeps me comfortable if not clear. I have tried amevive,protropic,psorcon,dexamethosone and many others. But only remicade for the joint pain.
Report This| Share this:Understanding Psoriatic ArthritisI was diagnosed with psa at the age of 38, moderate to severe psoriasis and moderate psa. I currently take methotrexate injects weekly and remicade once a month. Remicade started out wonderfully cleared the skin up and pain free joints but now after 5 years it only helps with the joints for a couple of weeks and my legs from the knees down are almost completely covered. I have tried many treatments for the skin but found that for me the best treatment is clobetsol with Xclair cream keeps me comfortable if not clear. I have tried amevive,protropic,psorcon,dexamethosone and many others. But only remicade for the joint pain.
An_188213 responded:
I was diagnosed with osteoarthritis in 1980. I was just diagnosed with guttate psoriasis 6 weeks ago. My dermatologist keeps asking about my joint pain but it seems no worse. Would I have psoriatic arthritis or just arthritis along with psoriasis? Will my joint pain get worse because of this? Thank you
Report This| Share this:Understanding Psoriatic ArthritisI was diagnosed with osteoarthritis in 1980. I was just diagnosed with guttate psoriasis 6 weeks ago. My dermatologist keeps asking about my joint pain but it seems no worse. Would I have psoriatic arthritis or just arthritis along with psoriasis? Will my joint pain get worse because of this? Thank you
ravetildon responded:
age 34 now, realized I had it about 2 years ago. Has normal psorasis since 10....
Started out with tylenol, meth, sulfasalizine... None did anything...
Currently taking 50 mg enbral once week. It's doing a pretty good job with joint pain; didn't help with psoriasis at all. It actually made it worse...
I have been having pretty severe memory & recall issues, headaches, & eye pain & fogginess.
Any suggestions on what to do? Got a full medical eye exam they said everything is perfect there. primary doc doesn't really have anything to say...
Any ideas on what I should do? I'm in the Pleasanotn, CA USA area.
Started out with tylenol, meth, sulfasalizine... None did anything...
Currently taking 50 mg enbral once week. It's doing a pretty good job with joint pain; didn't help with psoriasis at all. It actually made it worse...
I have been having pretty severe memory & recall issues, headaches, & eye pain & fogginess.
Any suggestions on what to do? Got a full medical eye exam they said everything is perfect there. primary doc doesn't really have anything to say...
Any ideas on what I should do? I'm in the Pleasanotn, CA USA area.
Report This| Share this:Understanding Psoriatic Arthritisage 34 now, realized I had it about 2 years ago. Has normal psorasis since 10....<br /><br />Started out with tylenol, meth, sulfasalizine... None did anything...<br /><br />Currently taking 50 mg enbral once week. It's doing a pretty good job with joint pain; didn't help with psoriasis at all. It actually made it worse...<br /><br />I have been having pretty severe memory & recall issues, headaches, & eye pain & fogginess.<br /><br />Any suggestions on what to do? Got a full medical eye exam they said everything is perfect there. primary doc doesn't really have anything to say...<br /><br />Any ideas on what I should do? I'm in the Pleasanotn, CA USA area.
lehmanfarm responded:
I was dx with PSA when I was 37 I am now 50. Altho I had joint problems since my early 20's. Psoriasis not too bad only occasional flare ups, but severe arthritis. Neck, TMJ, shoulders, hips, knees ankles and feet. Biologicals work the best but I get lots of infections while on them. It is a delecate balance. Currently on Orencea doing ok on it but causing sinus inflammation problems. I currently take prednisone and sulindac to help with inflammation and oxycodone for pain. I have had surgery on my TMJ and my hip already. Problems with my quad tendon it has tears. A slow pace walk in the morning does help loosen me up and I try not to sit too long. I never know what the day will bring.
Report This| Share this:Understanding Psoriatic ArthritisI was dx with PSA when I was 37 I am now 50. Altho I had joint problems since my early 20's. Psoriasis not too bad only occasional flare ups, but severe arthritis. Neck, TMJ, shoulders, hips, knees ankles and feet. Biologicals work the best but I get lots of infections while on them. It is a delecate balance. Currently on Orencea doing ok on it but causing sinus inflammation problems. I currently take prednisone and sulindac to help with inflammation and oxycodone for pain. I have had surgery on my TMJ and my hip already. Problems with my quad tendon it has tears. A slow pace walk in the morning does help loosen me up and I try not to sit too long. I never know what the day will bring.
saraande1977 responded:
I was diagnosed with PSA when I was 30 years old. My doctor classifies my Psa as severe. My Psoriasis on my skin is not bad at all with medication. I have maybe a tiny patch on my knee and the rest is completely clear. Before being diagnosed my entire scalp was covered, some of my face, elbows, & knees. I was diagnosed with Psoriasis when I was about 25. I started out with methotraxate and enbrel. I failed the Enbrel in about 3 months and my liver went out of control with methotrexate. I was then put on Arava and Remicade. I have used Remicade for about 2 years and my doctor recently took me off because the effectiveness was not lasting the full 8 weeks. He then put me on Humira. So far the Humira has worked but I have had to go in for severe wrist pain and swelling in my tendons. I have had to take big doses of Prednisone to get the swelling down. I might have to switch to Symponi if the Humira does't work. Very frustrating.
Report This| Share this:Understanding Psoriatic ArthritisI was diagnosed with PSA when I was 30 years old. My doctor classifies my Psa as severe. My Psoriasis on my skin is not bad at all with medication. I have maybe a tiny patch on my knee and the rest is completely clear. Before being diagnosed my entire scalp was covered, some of my face, elbows, & knees. I was diagnosed with Psoriasis when I was about 25. I started out with methotraxate and enbrel. I failed the Enbrel in about 3 months and my liver went out of control with methotrexate. I was then put on Arava and Remicade. I have used Remicade for about 2 years and my doctor recently took me off because the effectiveness was not lasting the full 8 weeks. He then put me on Humira. So far the Humira has worked but I have had to go in for severe wrist pain and swelling in my tendons. I have had to take big doses of Prednisone to get the swelling down. I might have to switch to Symponi if the Humira does't work. Very frustrating.
I recommend that you talk to a rheumatologist about your situation, and whether the joint pain will be any different as a result of having guttate psoriasis.
Report This| Share this:Understanding Psoriatic ArthritisI recommend that you talk to a rheumatologist about your situation, and whether the joint pain will be any different as a result of having guttate psoriasis.
I recommend that you see a dermatologist for the psoriasis and a rheumatologist for the psoriatic arthritis, and have them coordinate your care. Please go to the website for the National Psoriasis Foundation, www.psoriasis.org , and then click on the physician directory, and you will locate individual physicians for each of these specialty practice areas within a reasonable distance from your residence.
Report This| Share this:Understanding Psoriatic ArthritisI recommend that you see a dermatologist for the psoriasis and a rheumatologist for the psoriatic arthritis, and have them coordinate your care. Please go to the website for the National Psoriasis Foundation, <a rel="nofollow" href="http://www.psoriasis.org">www.psoriasis.org</a> , and then click on the physician directory, and you will locate individual physicians for each of these specialty practice areas within a reasonable distance from your residence.
What you are describing is, unfortunately, not that uncommon. Several of our PSA patients have had to try a number of available treatment options, sometimes in combinations, in order to identify the right one for them. Your dermatologist and rheumatologist can advise on which ones are more likely to work for you, based upon your medical history, and can also advise if a combination therapy should be taken.
Report This| Share this:Understanding Psoriatic ArthritisWhat you are describing is, unfortunately, not that uncommon. Several of our PSA patients have had to try a number of available treatment options, sometimes in combinations, in order to identify the right one for them. Your dermatologist and rheumatologist can advise on which ones are more likely to work for you, based upon your medical history, and can also advise if a combination therapy should be taken.
Got2talk responded:
I was diagnosed with psoriatic arthritis at about age 49. So far I have had a spinal fusion, left ankle replacement (traumatic arthritis-broken at age 19) and planned knee replacement next month. I occassionally have an outbreak of skin psoriasis in one spot; back of thigh, elbow or knee.
Degenerative disc disease in my back which I attribute to heredity.
I have been taking celebrex for approximately 11 years. Not sure it is really working as well anymore. What are other solutions to the pain. Back is worse since my knee issues; can't walk as much. Sedentary lifestyld is wreaking havoc with the pain.
Degenerative disc disease in my back which I attribute to heredity.
I have been taking celebrex for approximately 11 years. Not sure it is really working as well anymore. What are other solutions to the pain. Back is worse since my knee issues; can't walk as much. Sedentary lifestyld is wreaking havoc with the pain.
Report This| Share this:Understanding Psoriatic ArthritisI was diagnosed with psoriatic arthritis at about age 49. So far I have had a spinal fusion, left ankle replacement (traumatic arthritis-broken at age 19) and planned knee replacement next month. I occassionally have an outbreak of skin psoriasis in one spot; back of thigh, elbow or knee.<br /> <br />Degenerative disc disease in my back which I attribute to heredity.<br /> <br />I have been taking celebrex for approximately 11 years. Not sure it is really working as well anymore. What are other solutions to the pain. Back is worse since my knee issues; can't walk as much. Sedentary lifestyld is wreaking havoc with the pain.
An_228238 responded:
In 2009, I was 55 yrs old when I woke up one morning while on vacation and could not get out of bed. I had no strength and pain in my shoulders, knees, hips, ankles, hands. I couldn't get dressed. I have worked construction since I was 16 and never lost time from work due to illness. I went to my GP who put me on Prednisone and told me to see a rheumatologist. My wife has SLE so I knew what a rheumatologist was and knew it was not something good. The first rheumatologist had me on Prednisone, and methotrexate, and infusions of Remicade. After a year, I still did not feel better. (The first diagnosis was Polymyalgia Rheumatica, and after more blood work, was diagnosed with Psoriatic Arthritis.) The second dr I saw took me off the Remicade but kept me on methotrexate until she was sure about the diagnosis. (I take methotrexate on Saturdays and by Thursday night the pain is increasing.) Now I took my methotrexate on July 2nd and had my first injection (Humira Pen) on July 3rd. When Thursday rolled around I expected to start feeling achy but I didn't. When I took my methotrexate on Saturday, I was actually felt well enough to take the dog for a walk on Sunday. I hope this is a sign that Humira is going to work for me.
Report This| Share this:Understanding Psoriatic ArthritisIn 2009, I was 55 yrs old when I woke up one morning while on vacation and could not get out of bed. I had no strength and pain in my shoulders, knees, hips, ankles, hands. I couldn't get dressed. I have worked construction since I was 16 and never lost time from work due to illness. I went to my GP who put me on Prednisone and told me to see a rheumatologist. My wife has SLE so I knew what a rheumatologist was and knew it was not something good. The first rheumatologist had me on Prednisone, and methotrexate, and infusions of Remicade. After a year, I still did not feel better. (The first diagnosis was Polymyalgia Rheumatica, and after more blood work, was diagnosed with Psoriatic Arthritis.) The second dr I saw took me off the Remicade but kept me on methotrexate until she was sure about the diagnosis. (I take methotrexate on Saturdays and by Thursday night the pain is increasing.) Now I took my methotrexate on July 2nd and had my first injection (Humira Pen) on July 3rd. When Thursday rolled around I expected to start feeling achy but I didn't. When I took my methotrexate on Saturday, I was actually felt well enough to take the dog for a walk on Sunday. I hope this is a sign that Humira is going to work for me.
Snap54 responded:
In 2009, I was 55 yrs old when I woke up one morning while on vacation and could not get out of bed. I had no strength and pain in my shoulders, knees, hips, ankles, hands. I couldn't get dressed. I have worked construction since I was 16 and never lost time from work due to illness. I went to my GP who put me on Prednisone and told me to see a rheumatologist. My wife has SLE so I knew what a rheumatologist was and knew it was not something good. The first rheumatologist had me on Prednisone, and methotrexate, and infusions of Remicade. After a year, I still did not feel better. (The first diagnosis was Polymyalgia Rheumatica, and after more blood work, was diagnosed with Psoriatic Arthritis.) The second dr I saw took me off the Remicade but kept me on methotrexate until she was sure about the diagnosis. (I take methotrexate on Saturdays and by Thursday night the pain is increasing.) Now I took my methotrexate on July 2nd and had my first injection (Humira Pen) on July 3rd. When Thursday rolled around I expected to start feeling achy but I didn't. When I took my methotrexate on Saturday, I was actually felt well enough to take the dog for a walk on Sunday. I hope this is a sign that Humira is going to work for me.
Report This| Share this:Understanding Psoriatic ArthritisIn 2009, I was 55 yrs old when I woke up one morning while on vacation and could not get out of bed. I had no strength and pain in my shoulders, knees, hips, ankles, hands. I couldn't get dressed. I have worked construction since I was 16 and never lost time from work due to illness. I went to my GP who put me on Prednisone and told me to see a rheumatologist. My wife has SLE so I knew what a rheumatologist was and knew it was not something good. The first rheumatologist had me on Prednisone, and methotrexate, and infusions of Remicade. After a year, I still did not feel better. (The first diagnosis was Polymyalgia Rheumatica, and after more blood work, was diagnosed with Psoriatic Arthritis.) The second dr I saw took me off the Remicade but kept me on methotrexate until she was sure about the diagnosis. (I take methotrexate on Saturdays and by Thursday night the pain is increasing.) Now I took my methotrexate on July 2nd and had my first injection (Humira Pen) on July 3rd. When Thursday rolled around I expected to start feeling achy but I didn't. When I took my methotrexate on Saturday, I was actually felt well enough to take the dog for a walk on Sunday. I hope this is a sign that Humira is going to work for me.
Byroney_WebMD_Staff replied to Got2talk's response:
Welcome Got2Talk!
I am sorry to hear about your health challenges. Have you talked to your rheumatologist about your concerns about your mobility and whether or not your treatment is still working? In the past 11 years, there have been changes and there may be new options that would help you, not to mention physical therapy and others.
As far as the pain, have you asked your doctor about a Pain Mangement Clinic ? They're the experts on helping folks with pain. You may want to check out our Pain Management Community for more support.
Let us know how you're doing,
Byroney
I am sorry to hear about your health challenges. Have you talked to your rheumatologist about your concerns about your mobility and whether or not your treatment is still working? In the past 11 years, there have been changes and there may be new options that would help you, not to mention physical therapy and others.
As far as the pain, have you asked your doctor about a Pain Mangement Clinic ? They're the experts on helping folks with pain. You may want to check out our Pain Management Community for more support.
Let us know how you're doing,
Byroney
Even if you're on the right track, you'll get run over if you just sit there. ~Will Rogers
Report This| Share this:Understanding Psoriatic ArthritisWelcome Got2Talk!<br /> <br />I am sorry to hear about your health challenges. Have you talked to your rheumatologist about your concerns about your mobility and whether or not your treatment is still working? In the past 11 years, there have been changes and there may be new options that would help you, not to mention physical therapy and others.<br /> <br />As far as the pain, have you asked your doctor about a <a href="http://www.webmd.com/pain-management/pain-clinics-overview">Pain Mangement Clinic</a> ? They're the experts on helping folks with pain. You may want to check out our <a href="http://exchanges.webmd.com/pain-management-exchange">Pain Management Community</a> for more support.<br /> <br />Let us know how you're doing,<br /> <br />Byroney
AmyCat5 responded:
I've had psoriasis since the age of 19. Currently, I only have a little bit on my scalp and on each knee. I don't use any medicine right now since it is very mild. I realized I had psoriatic arthritis when I was 34. I hit my foot on the bottom of a door and that set off the reaction. It's on the pads of my feet, a few toes, and on one hand. It hurt terribly to walk. I tried prednisone, methotrexate, naproxen, diclofenac. None really helped and I had different illnesses and infections this past year which I never had before (I blame the Methotrexate). I've been taking Celebrex for a couple of weeks now and can't believe the difference. I actually walked on the treadmill yesterday for the first time in 2 years. I hope it continues to work. Also, I am taking Doxycyline and giving the antibiotic approach a chance before starting the biologics. My old doctor did not want me to do this, so I have found a new doctor who will let me try that approach first.
Report This| Share this:Understanding Psoriatic ArthritisI've had psoriasis since the age of 19. Currently, I only have a little bit on my scalp and on each knee. I don't use any medicine right now since it is very mild. I realized I had psoriatic arthritis when I was 34. I hit my foot on the bottom of a door and that set off the reaction. It's on the pads of my feet, a few toes, and on one hand. It hurt terribly to walk. I tried prednisone, methotrexate, naproxen, diclofenac. None really helped and I had different illnesses and infections this past year which I never had before (I blame the Methotrexate). I've been taking Celebrex for a couple of weeks now and can't believe the difference. I actually walked on the treadmill yesterday for the first time in 2 years. I hope it continues to work. Also, I am taking Doxycyline and giving the antibiotic approach a chance before starting the biologics. My old doctor did not want me to do this, so I have found a new doctor who will let me try that approach first.
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