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Rheumatoid arthritis (RA) and psoriatic arthritis (PsA) overlap?
I've recently been told by my rheumy that she now believes that I have RA with a PsA overlap. The RA was definitively dx'd back when I was 52. I'm 69 now, but when I was 16 and again at 29 I was dx'd with lupus. That led to years of plaquenil and Nsaids and staying out of the sun. The RA was triggered by contracting Lyme and acute adult B-19 parvoviris at the same time. Within a few months following that my Rheumatoid factor shot way up and the joints most involved were hands and feet. I was kept on plaquenil and Enbrel was added. It worked really well for 8 years. Then I had a flare that led to a series of trails of other TNFi's and eventually a doctor switch. Rinvoq kept me sick with sinus infections constantly, so she recently switched me to Xeljanz and added Leflunomide. I'm not doing well at all. My hands are much worse, as in all fingers joints are getting bigger. All nails are affected. My feet are terrible, as are both ankles. I have been told it is possible to have PsA without the psoriasis, and I don't have any plaques or rashes other than some JAKne from the Xeljanz. I love to hear from someone else about this. I feel like it's a double whammy. I also have colitis and secondary adrenal insufficiency which requires daily prednisone. Clearly, I'm not very healthy haha. Let me know what you think.
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My experience with PsA was that the skin signs of psoriasis can be very subtle. If you have had nail problems in the past that can be a symptom.Thereis no
indicative blood test for psoriasis so it is a clinical diagnosis often requires a dermatologist to make the call. You have had some drugs that might treat PsA
so you may need to wait longer to assess JAK inhibitor
results. Have you had an opinion from a university med center or a tertiary referral clinic since your situation is
complex?
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2 Reactions@rdf56, According to the Arthritis Foundation, it is possible to have PsA without psoriasis - https://www.arthritis.org/diseases/more-about/expert-q-a-psa-without-psoriasis. I'm sorry to hear that you are struggling to find a better treatment. Hoping other members with some experience will be able to offer some suggestions. You are not alone. I did a search of Connect for members posting about rheumatoid arthritis with psoriatic arthritis and found a few discussions along with quite a few comments. Here is the search link that lists the discussions and comments if you want to scan through them while you wait for others to respond - https://connect.mayoclinic.org/search/discussions/.
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2 Reactions@seniormed
Thank you for your response. My doc did her rheumy fellowship at Hopkins- Internal Medicine board certified as well. She's young (42) & still has access to JHH
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1 Reaction@johnbishop THANKS! Very helpful. I appreciate this info.
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1 ReactionHi @rdf56, your medical history and current symptoms sound very similar to mine, although I can’t tolerate JAK inhibitors.
May I ask whether you’ve ever had an ACTH stimulation test for adrenal insufficiency? If so, the results might suggest switching from cortisol to hydrocortisone replacement.
Also, do your fingernails look consistent with classic nail psoriasis? And when was the last time you had ELISA testing for lupus or any vascular/autoimmune workup?
I’m asking because some of my symptoms became significantly worse after I was also diagnosed with APS (antiphospholipid syndrome). In my case, it seemed to contribute to both uncontrolled inflammation and accumulated joint damage.
@swalex
Hi, what is your diagnosis and your symptoms?
I have systemic sclerosis/scleroderma (skin thickening) with inflammatory arthritis manifested by swollen joints with thinning scaly skin over joints and purple skin striations. These changes to the joints have happened recently, and my rheumy is not sure if this is a new PsA, or SSc progression. Dermatomyositis test came in negative. I have just started Humira injections. Too early to see much improvement. I am trying to understand what worked for other patients with these symptoms.
@swalex
Hi, Swalex. Thank you for your comments. The doc does the ELISA testing every 6 months. It's due again in July. My adrenals are completely non productive and the ACTH test has been done repeatedly, with 7am cortisol levels. It's never in the normal range. The endocrinologist said we don't even need to test anymore. I was initially put on cortisol instead of prednisone, but I felt like my day was "too uneven" if that makes sense. I'd take the morning dose and feel like crap before the next dose, so since prednisone is long acting, I've been able to experience a more even keel, so to speak. My biggest issue with any of the biologics or JAK's is that I catch literally anything that comes down the pike and I've got 5 grandkids under the age of 5, so someone is always germy & I refuse to wear masks around them. If my kids need me I'm there. This means I have to constantly alter my prednisone doses because I get sick a lot. Obviously, I've been on and off steroids since I was a teen, but it was the Budesonide for colitis that finally did me in on that score. I'm off it now as it happens that the Xeljanz has put it under control pretty decently. The nail pitting & black lines showed up a couple of years ago, and there are nail issues on my feet as well. It wasn't until my joints at the figure tips started to get bad rapidly, that the rheumy suggested the PsA thing and said it didn't matter that I hadn't shown the skin symptoms, which she said could still show up eventually. O joy! There's so much crossover between all these diseases, that it's no longer much of a surprise to me when something else shows up. I actually had an internist once suggest when I was only 16, that my allergies asthma, uveitis, and lupus rash was all due to the "trauma" of being adopted as a 3 day old infant! Who knows, maybe he was right! But I pay attention to everything and I'm a good researcher, as I spent 15 years in Medical Malpractice (plaintiff work), before 3 small kids and a job became too much and I retired early. I always ask a lot of questions and plenty of docs find that tiring I'd bet. Just yesterday, a podiatrist kept trying to cut things short! I've got a lot of patience for doctors. They're just people and they can't do it all. Plenty of them get sick too and they also tend to be lousy patients. Lol. I'm lucky to have all mine and I've got quite a few. Good luck to you. Take care
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1 Reaction@altabiznet
Uveitis, systemic lupus, RA, colitis, severe secondary adrenal insufficiency, cardiac bigemeny, lipid issues from Xeljanz, and a worthless immune system, haha. My joint issues are the biggest issue besides infection. I've had a knee replacement, a thumb joint replacement (awful) and the last orthapod said I need a triple ankle arthrodesis, which I refused. With all my issues I'd never recover. Humira worked for me for about a year, so good luck to you. Hopefully, it will work for a long, long time for you.
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2 ReactionsHi @rdf56, thanks for your answer.
I’m glad to hear you’re happy with your doctors.
Regarding the “nail pitting & black lines showed up a couple of years ago” — in my case, I had dark lines in my nails that were linked to excess iron exposure from old rusty water pipes in the house, as well as deficiencies in vitamin B12, vitamin D, and protein.
You mentioned that your adrenals are completely non-productive. I assume your endocrinologist has ruled out hypopituitarism, meaning possible damage or reduced function of the pituitary gland?
Yes, as a grandma you’re exposed to everything the grandkids bring home.
Wishing you all the best.
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1 Reaction@swalex
Thanks again. Probably not too much iron. Filtered water and usually I'm anemic anyway. Didn't have old pipes when the nail stuff started either, although my pipes now were born a year before me! We had to move to an old rancher to get away from steps, for my husband's knee and hip replacements, not to mention my lousy walking and climbing abilities. And no, I'm not sure about the pituitary. She's only ever treated the adrenal stuff that was originally dx'd by my PCP and ultimately, an ending at Hopkins. Lordy, I don't need anything else. I really hope you're doing better soon. You've got enough to deal with as well. Thanks for your interest in my story. You seem to be a very empathetic soul. I can appreciate that.
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