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Date: 22.03.2014
From: Fiona

Subject: PsA or OA and does it matter? (New and confused!)

Hello, I'm new here and hoping someone may be able to help... :)

My questions are, could I have psoriatic arthritis rather than OA, and if so, does it matter...?

I have been diagnosed with multi-site OA and hypermobility syndrome. I have arthritis confirmed in my knees, R hip, hands and jaw, and I suspect my ankles, feet and R shoulder/neck and possibly lower back are arthritic as well, but they haven't been x-rayed. Basically, I hurt almost everywhere, I am often exhausted, and my mobility is badly impaired - I now have a blue badge.

My diagnoses only came within the past few months after years of problems - but now I'm due to have a hip replacement in May, so everyone's focus has been on that.

They have tested me several times for RA - I think because my symptoms came on quite suddenly about 3-3.5 years ago, because I have deteriorated faster than people with OA usually do, and because my father had a diagnosis of RA - but RF and CRP (and something else) are all normal.

I stumbled upon some info about PsA which makes me wonder whether I have this. I have a few tiny patches of something like psoriasis - about 4 patches each about 1-1.5cm near both elbows and the tops of both thighs. I have two slightly swollen toes and the nail on one of them is thick, twisted and yellowy. But because these things cause me very little problem - especially compared to my joint pain and inability to walk - I haven't really thought about them. When the rheumy asked me if I had any skin problems, I said "Not really".

Does anyone think I might have PsA rather than OA? Should I go back to my GP or rheumy and ask? Might it change my treatment or anything else if I have been misdiagnosed? I am already being seen by an orthopaedic surgeon, occupational therapist, podiatrist, physio and bowel surgeon, so maybe I'm already getting all the support I need?

Any advice welcome, and thanks for reading to the end if you have!
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Date: 22.03.2014
From: marlene

Subject: Re: PsA or OA and does it matter? (New and confused!)

Hi Fiona and welcome.
I have always been treated for OA since my 30s now in my 60s and just recently mentioned on here that I have psoriasis and Colin (a lovely guy on here) asked if there was a chance I had PA. Like you I was tested for RA had lots of scans and told OA in most joints.
So I think you should mention your psoriasis to your Rheumy mainly because the different types of Arthritis are treated different. I have a GP appointment on 7th April and will definitely be mentioning it.
I hope this helps you and I am sure you will get some other replies maybe a bit more informative than mine.
Take care.
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Date: 22.03.2014
From: Fiona

Subject: Re: PsA or OA and does it matter? (New and confused!)

Thank you Marlene. :)
The thing is, I don't even know if the tiny patches I have ARE psoriasis. And I'm wary of being seen as (even more of) a hyperchondriac. :(
But you're right, I should probably mention it next time I'm at the doc's...
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Date: 22.03.2014
From: Colin W

Subject: Re: PsA or OA and does it matter? (New and confused!)

hi Fiona , it does matter because with OA they wont give you the drugs to control the arthritis & if you got psoriasis & arthritis there is good chance they are linked
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Date: 22.03.2014
From: Fiona

Subject: Re: PsA or OA and does it matter? (New and confused!)

Thanks Colin. :) You're right I haven't been offered anything other than pain killers... So it seems important to know whether this could be PA, but I'm really not sure...
I'd be interested to hear from anyone else who has PA but hasn't got much in the way of skin symptoms...?
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Date: 23.03.2014
From: helen

Subject: Re: PsA or OA and does it matter? (New and confused!)

Hello Fiona. I have PSA and osteo in both knees toes and neck. Iv suffered with psoriasis since I was 10 I'm now 47. I have spots on my legs and head and around ears they are white scales that can come off by scratching then they reform again its layers and layers of dead skin. My toe nails are yellow and have ridges and very hard to cut. Iv been told they will or can fall off and re grow again. I have sausage toes and fingers. Iv had three different types of drugs but suffered with side effects so nothing ATM. Methothrexate helped with my spots. My crp was 13 and consultant doesn't want to treat me as fibro has taken over my body with pain. I would show ur go/consultant about the spots to to get peace of min. Xx
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Date: 24.03.2014
From: Fiona

Subject: Re: PsA or OA and does it matter? (New and confused!)

Thanks Helen. One of my toenails is as you describe, and I have noticed that that toe and one or two others are slightly swollen... But basically my skin/toe symptoms are much milder than you describe, which makes me doubt whether what I have is PsA... But on the other hand, my arthritis is much more 'aggressive' than OA normally is, which makes me wonder about another explanation...
The rheumy discharged me to the orthopaedic surgeon and community care, so I'd have to ask for a re-referral... I think I'll see what my GP thinks, and take it from there.

I still wondering whether there is anyone else here who has a diagnosis of PsA with only 'mild'/limited skin problems...?
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Date: 15.04.2014
From: margaret

Subject: Re: PsA or OA and does it matter? (New and confused!)

Hi Fiona OA can come on quickly I started having pains in my groin in the spring of 2010 went to doctor in June diagnosed after x-rays in August hip replaced March 2011 less than a year later. I now have OA in fingers ,pelvic area, spine,knees and ankles. I was so down at first as I had previously been so fit and active, this forum helped so much, I also have psoriasis and have just had tests for PsA they say I'm clear but I do suffer from cracking fingernails and fatigue, and I take vitamin D supplement(prescribed) Mine started 3 years ago when in my 50s I am now just 60. They do tend to treat one area when they find something rather than looking at the overall picture. All forms of arthritis can be devastating it changes your life and that of your family it can leave you feeling depressed, a time waster, worthless. Consultants can often be less than supportive but keep on at them tell them everything let them groan all they like, at the end of the day they are there to help you, that's what they are paid for.
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Date: 15.04.2014
From: Fiona

Subject: Re: PsA or OA and does it matter? (New and confused!)

Thanks Margaret. My arthritis has deteriorated very fast - basically my hip was showing 'normal' wear and tear for my age and weight in April 2012 and 'severe' arthritis with a complete loss of joint space, large osteophytes and sclerosis by Aug 2013. I'm having a hip replacement in 3 weeks. :-/ I also now have it confirmed in my feet, knees, hands and jaw, and I suspect my ankles, back and R shoulder. I am only 48.

I've been tested for RA 3 times - all clear. I showed my toe to my GP last week and he is satisfied it's not psoriatic nail disease... My skin patches are very small and uncertain.

I have hypermobility syndrome - I was extra bendy when young - so the 'best guess' seems to be that I have just worn my joints out early... :(

It's good news the docs don't seem to think it's RA or PsA... But I just have a lingering worry that they might be wrong and I may be missing out on treatment that could prevent further deterioration...
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Date: 22.04.2014
From: margaret

Subject: Re: PsA or OA and does it matter? (New and confused!)

I share your concerns my psoriasis flares up mainly on my legs but I to have the smaller patches no one seem overly concerned but it always seems to come before a really bad bout of joint pain, I was a very successful and busy hockey player and I have been told that the injuries I sustained are partly to blame. Good luck with the hip replacement I'm sure it will be fine but if you have any probs afterwards insist on being seen, also insist on good physio they are a tremendous help. Keep in touch we will all be routing for you.
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