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Living with Psoriatic Arthritis (PsA)

PsA...only one of Five types?

New to all this but can a person have more than one of the five types ? I have very symmetrical symptoms, all limbs…but I also have bad lumbar and SI pain.

No ‘sausage’ fingers, just a lot of pain.

Rheumie gave me a jar of prescription diclofenac…don’t know where to start applying it !! :neutral_face:

Hello there!

I’ve never taken a blind bit of notice of the types. As far as I can tell, PsA does what it likes.

Additionally, the various classifications are being re-thought I believe, though I’ve not taken a lot of notice of these developments due to the attitude mentioned above.

Where to put the diclofenac … I see the problem! I guess on joints, whichever joints are most troublesome. Is there any other treatment being considered?

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I never paid a lot of attention to the types, except to note that mine is mostly symmetrical. The only one that would seriously worry me is the mutilans type.

If you have a lot of swollen and painful joints than you should consider asking about an oral nsaid. Plus start pushing towards systemic treatment. Why wait when damage can be happening? I know some countries require that a person fails multiple treatments before being eligible for biologics. All the more reason to get started!

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I have started Plaquenil - not even a week in so that will take awhile.

Slept with a heating pad on my back last night just to keep sleeping - knees & ankles & hands very sore as well (elbows, feet…etc.)…hence the question about more than one type.

I don’t swell much at all…at least not visibly. My rheumie pointed out some inflammation in my wrist but I can’t see it. All I know is a heck of a lot of pain, fatigue…ugh.

Interesting that people seem to not fit into one type so perfectly. FWIW, I had psoriasis in my teens (scalp, possibly knees)…been almost 9 years trying to find out why I am in so much pain & it has been progressive - worst year ever (50 now). I have modified my life a lot !

I’ve started having “sausage” fingers in for it my fingers. Wrists, hands, knees, ankles, feet and back hurt. My rheumie just took me off plaqeunil and now I’m waiting to find out if insurance will pay for cimzia. I didn’t know there were different types of PsA

More than ‘types’ PsA can be part of a wider group of conditions https://www.arthritis.org/about-arthritis/types/spondyloarthritis/. Thankfully, I am clear of one of these. Anything that involves inflammation can be linked. From personal experience, also uveitis, costochronitis and maybe autoimmune pancreatitis.

You don’t have to fit into just one box!

The really positive note for me was realising that there is one common cause for quite a few things. Also that they weren’t in my imagination!

Find the right drug for you (DMARD, or similar), and it can treat multiple things in one go.

Use the gel where the inflammation is close to the skin. Chest is good for me. Also good on my fingers, but careful what you are doing with this all over your hands! Pointless putting it on my knees, as the inflammation is deep in the joints.

I think the only diagnosis worth much is a diagnosis of inflammatory arthiritis. Once it’s been established that your immune system is attacking you needlessly (as in you have inflammatory arthritis) then at least the right meds such as DMARDs and/or bioloigcs can be prescribed in an attempt to get your now insane immune system behaving better. Sadly nothing else much works for inflammatory arthritis regardless of which type it’s called.

They can do testing to see if you’ve got the rheumatoid factor, I do minimimally but had psoriasis really badly for some years so my diagnosis is firmly PsA. They can test for the HLBA (or whatever it’s called) gene, if you have that it’s more likely your inflammatory arthritis is PsA apparently. And so on. But seriously you just need a diagnosis of inflammatory arthritis to get on the right meds anyhow.

And believe it or not once a med starts working and quelling things down considerably, it can be quite astonishing how much of your life you can get back. So push for the strongest most effective med your rheumy is willing to prescribe.

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Not sure how the different types of PsA manifest. As for the diclofenac, it needs to be rubbed into the painful joints, as directed. Given your pain level, there are prescription NSAIDs such has Celebrex that can really help. It has recently come off patent and is sold as generic Celecoxib. Hopefully, your rheumatologist is treating for–what sounds like–active PsA.

My doctor thinks I have a mixture which has made it difficult to pick which protein to attack with meds. She is at a large university and said the most common is treated first and if you fail several drug trials, they move on the the next and yes sometimes treat different proteins simultaneously with several drugs.

I have at least five types…

One in my feet, one in my knees, one in my hips, one in my shoulders, one in my hands…

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The types essentially note where it starts from there they usually decide whether to concentrate on axial or peripheral symptoms. As @jrw9 noted that directs medication. The bios are effective for axial involvement but not so much for peripheral. That’s where the new “triple therapy” approach is taking over - Bio + DMARD + NSAID The up to date Rheumies are ignoring the “MTX isn’t effective studies” as they know different meds work for different things. None of the effacy studies consider more than one sub-set of symptoms at a time. They study one and ignore the others. I honestly have never seen a member here with active disease who has it somewhat under control with a single family of meds.

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Wowzer, that’s food for thought.

There again, if they are on single therapy and don’t currently have active disease, then it is under control, surely(?). Edit: I get what you mean! Sorry, we’ve had a lovely day today & wine was a factor.

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I did really well on Enbrel alone for about 4 years. It’s just been this past year that my psoriasis has been flaring up like crazy where I’m starting to accept the fact I’ll need to change bios. I wouldn’t care to take a DMARD, too, because I already have chronic low white cells (leukopenia). I take NSAIDS
very rarely—once-in-awhile only when my pain is unbearable. And I’m sure most if not all of my pain comes from joint erosion that happened before I started taking Enbrel.
I recall reading something about Enbrel not being as good for psoriasis—not as effective—so I wonder if that’s true, would I be better off switching to Humira? (I’m skeptical of some of the newer bios—I haven’t heard enough about any one of them to feel comfortable with them just yet!).

Why not add something like DUOBRII orTaltz that can be taken with Enbrel (there is a bunch of others now) Humira IMO is one you don’t want to take if anything else will work. Humira is unique in that it’s the only bio that works on the eyes. If you don’t have eye problems my thought is to save it. I’d visit with a dermi about the P if Enbrel is working otherwise. Ride these puppies till they buck you off.

Thank you, @tntlamb…I will look into the two you mentioned…I’m not sure if my eye problems are PsA-related or not. I’ve never gotten a definitive answer about that, so but maybe I shouldn’t consider Humira now. I have been thinking of seeing the dermatologist and hoping she has some simple remedies…I’d sure like to stay on Enbrel as it’s done so much for my PsA. Clobetasol, Betamethosone, sunshine—none of those seem to be helping much, other than stopping the itch temporarily.

It seems like almost all connective tissue in my body under attack including debilitating fatigue, episcleritis and dry eye…The chronic soreness lingers on if I apply the slightest pressure to any part of my body. The Stelara gives some relief with the skin and IBD symptoms but I just experienced a “break glass” in case of an emergency situation… Massive acute flare in lower back/pelvic area. Any movement caused breathless pain. Started a Predisone 1 week taper at 30mg . Within 24 hours the steroids reveal how invasive and widespread the inflammation has progressed over the past 3 years. I actually forgot what it was like to feel somewhat normal. It’s like a temporary escape from hell but knowing you have to go back. I pray this flare subsides before the steroids wear off. If the back/pelvic agony returns with a vengeance… any suggestions ?.. possibly nerve block or injections ? I’m a primary caregiver for my disabled wife and I’m self employed and need to work full time.

Wow, that describes it to a tee!!!
As far as what to do about your back…I’ll tell you what I did for mine. Rest, rest, rest at first (I hope that’s an option for you). Lots of pain meds (ibuprofen-the daily max) and icing alternating with heat. After 48 hours you can do MILD exercise—I mean MILD! Basically a lot of all of the above for a couple weeks. After which time you spend the rest of your life being extremely careful with lifting, bending and moving in any way—basically anything that can put your back out again!!!
Good luck!

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Thanks so much for the response Grandma_J…At 30mg… it was like an out of body experience. I never felt so good (in such a long time) …at least for the past 3 years. Only 1 problem…I’m usually in a coma for at least 9 hours and still have trouble coming out of it. Now I need clamps to keep my eyes shut ! The vaca was short though…I’m now at 15mg and the pelvic pain is starting to come back with a vengeance. I can handle the daily soreness and chronic fatigue while it comes and goes in waves but this pelvic/back thing is out of my league…way to invasive, distracting and debilitating and I’m scared that this will be potentially life long. I scheduled an appt. with a pain management anesthesiologist for next Thursday. Praying for a way to stop this…I can’t take narcotics because I work with embroidery machines that can hurt me if I’m not alert.

:+1:
Hang in there, @ThreadDesigns. The anesthesiologist will know what to do! Have you had an MRI to figure out if this pain refers from your spine?