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interesting site. I have had psoriasis for about for about five years (I
am 37 now) starting with an itchy patch on my lower leg which spread very
slowly in the immediate area. Classically it mirrored itself on the other
leg but in general it has never been that bad. It affects the creases
around my nether bits and sometimes around my ears but in listening to
other sufferers I am comparatively relatively lucky.
recently. About 8 months ago I felt a subtle stiffness in my hands and
through web research realised that psoriatic arthritis existed as a
condition. It worried me so I had the classic blood test for RA to rule it
out and possibly PA in. I have virtually no visible swelling in any joints
but felt my knees ached too much to be normal along with the pain in my
hands. I also hobbled in the morning with Achilles pain but thought
nothing of it as when warmed up it was much less of an irritant.
I visited a
rheum and he did extensive blood tests which revealed a very high RA
count! So do I have both? Neither? It worried me further but I was pleased
that whatever I had was being caught early and I just didn’t want it to
get worse. Because there is little obvious sign of arthritis, my rheum
decided to experiment with me. Clinically he said he was not willing to
rule anything in or out. He conceded there was inflammation based on the
pathology, that I had limited psoriasis and that I was obviously in some
form of pain. He then said that pain in my Achilles is classic to PA –
which I never new and believed the tendonitis was just there by
coincidence. He put me on a course of steroid tablets – Prednisolone and
NSAIDS — diclofenacs (Volterol) for a month and it proved amazing. My
limited but relevant to me pain vanished and no 45 second hobble in the
morning when I got up from sleep or from my car as the Achilles warmed up,
and no hand pain making me wary when I shook hands or opened a stiff jar.
problem is that after this experiment he mentioned that “as opposed to
20 years ago when arthritis was never detected early enough or treated
well even when it was detected, we can now do so much more and we have
caught me early, be it RA (count has since gone down on my second test but
still three times normal!) or PA ... so let’s put me on voltarol and,
wait for it, Methotrexate.” And this is where I am confused. He said the
prednisolone was kind of a bludgeon steroid in that it affects all the
immune system. Methotrexate attempts to affect the immune system relevant
to the arthritic condition. Yes he said, we have to watch your bloods, so
a monthly test is normal. No he said, it doesn’t stop you drinking the
few glasses of wine a night but excess is not recommended. Yes he said if
you were thinking of having a another child I would need to keep off the
methotrexate for 3 months. Quite frankly, it scared me and I opted to
leave it another month and just take the volterol if anything flared up. I
did not fancy agreeing to a life of a drug and a life of monthly blood
tests and, as for the drinking. I am m not sure whether he is right or
wrong given what I have read. Conversely I do not want this thing to get
worse. I have been disciplined enough to get it looked at early, so why
let it get worse and worry about anything irreversible happening?
after the month without anything other than the odd volterol, my hands
feel little pain and I think not as bad as before the prednisolone. As
your readers quite rightly say it is hard to know what one gets used to
and what is “normal.” However, my Achilles tendonitis on one foot
especially is back to its normal painful self. I am due to meet him in two
weeks to discuss tactics. I just hate the rather matter of fact fashion
these guys take to putting me on what seems to be a strong drug, but
excuse it by saying it will get rid of the pain. Thanks for listening.
Response: Hello, Stephen.
None of the red flags I'm aware of have been raised in your report.
I certainly agree with your Dr's suggestion that MTX (methotrexate) be
postponed until you've determined less aggressive treatments won't do the
trick. I wouldn't suggest that MTX is any less dangerous than the
systemic steroids (prednisolone) — it's just risky in a different way.
My own derm has been much more willing to have me on MTX for extended
periods than on systemic steroids (ingested AND injected). In the
long run, neither MTX nor the steroids will cure you. Some evidence
has been reported that MTX may even mask continuing joint damage from PA
— meaning that when the patient stops MTX (which, sooner or later, is
inevitable) s/he may find the condition worse than ever. Bear in
mind I've only heard this, about MTX, recently and (so far) from a single
(though credible) source.
Thanks for prompt response. Just after my writing this morning, my
other half rang me to say that on daytime TV (we actually have fewer of
these awful programmes than the US — although that says nothing of their
credibility!) they will be talking about a new injection that cures
psoriasis! I suspect it is linked to the increased awareness of P due to
the forthcoming Singing Detective
movie … where the world and his wife will claim they have all had P.
One last thing.
Do you know the one comment that always annoys me when you happen to
mention P or PA? Its when the response is “Well.
At least you don’t have something worse — like cancer.” Oh
Have a good morning. –Stephen T.