PsA or NOT PsA? Any ideas??

We don’t have a definitive lab or test for psoriatic arthritis. My psoriasis was
very minimal and my first rheumatologist gaslighted my suggestions that I fulfilled all the screening criteria for PsA. They stuck on osteoarthritis.
It can take time for the diagnosis to come to light. PsA is a disease with generalized systemic inflammation that does promote atherosclerosis and
cardiovascular risk. Our CRP can be normal in the face of ongoing vessel and organ inflammation. My cardiologist put me on statins and Q10 when the diagnosis was made. Humira has been shown to lessen cardiovascular risk.
Cardiac hsCRP is more sensitive. A newer test in the literature for potential
heart involvement in psoriasis is GlycA. My rheumatologist felt my CRP did not correlate with my symptoms. It is probable that we had systemic inflammation before we sensed any problem. Make sure your dermatologist,
rheumatologist and cardiologist are aware of all labs and history in coordination of your care and know your numbers. My part D tried to push me to the bio similar substitute and the specialty pharmacist helped me stay on Humira.

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Here is a link to a good article on psoriatic arthritis (PsA) at the Cleveland Clinic:
https://my.clevelandclinic.org/health/diseases/13286-psoriatic-arthritis#prevention
Have you made any diet changes? I have had psoriasis on my scalp for decades and I have been fighting PsA for a couple years. I have been avoiding red meats, dairy and tomatoes. That helped, but I found that free radicals cause inflammation at the joints and you need high amounts of anthocyanins to knock them out. Anthocyanins are what makes blueberries blue, black beans black and red cabbage red. Having a "black and blue and red" diet makes a big difference. The sharp pain in my joints are decreasing to very minimal amount. (I am not on any prescriptions.)

I agree and have found diet very important for symptoms.
I am doing Mediterranean with
gluten avoidance and cut alcohol
to 3 drinks a week for socializing.
Dark chocolate after dinner with
frequent colorful fruits and veggies as well. Vitamin D, statins.
turmeric and melatonin are all
antinflammatory supplements.

I believe the only way to get the diagnosis (I have PsA and the nail involvement). There is no test. It’s all about the symptoms and genetics. A good Rheumatologist should be able to figure it out.

The key is good rheumatologist. Many knee jerk to methotrexate as a therapeutic trial rather than work up a real accurate diagnosis

Can't get in to Rheumatologist until June here! I think Methotrexate has been ruled out for me due to risk to kidneys/liver. I also have to limit use of NSAIDS for the same reason.

Methotrexate is the first thing they give everyone. I could only tolerate it for 2 weeks and I said get me off this. Which she did. 9 biological later….