reactive or psoriatic, what are the differences?

kaytepops

Hi everyone, I think I joined this 5 years ago when I got reactive arthritis but once I recovered and finished uni my old email address was cancelled...alas now I am back.
I started having major left shoulder and neck pain about 2 weeks ago and thought it was an ear infection but then my left knee and foot started swelling up and I knew something was definitely wrong.
I was in Italy doing a work experience placement at the time and when the doctor diagnosed psoriatic arthritis I knew I had to come home.
I am now awaiting an appointment with rheumatology and the inflammation has spread to my left wrist and is v painful.
So I am just waiting really to find out which one it is, and hoping it is nowhere near as aggressive as last time, which took me out of uni for a year.
If anyone else has reactive/psoriatic and knows how u can tell the difference between them (my sister has psoriasis but I don't) would be great to chat! xx

tjt6768

I'm afraid I don't know the answer, just wanted to say I'm sorry that you've had to return...
I really hope they get you sorted out with the correct treatment soon.
Nice to meet you..
Be well

valval

sorry no help but bumping this up for some one to see val

dreamdaisy

Hello, I have PsA but it took years for that diagnosis to be made as I didn't have any of the skin trouble when I first saw a rheumatologist. I am not sure what the physical difference between the two is, but I think that a reactive arthritis is one that is caused by an infection in another part of the body and although it can take a while to clear it can (as you discovered). PsA is an auto-immune arthritis, i.e. the body attacks itself and as such it doesn't clear: meds are prescribed which suppress the immune system in an attempt to stop the process from happening. You mention that your sister has P so that to me indicates a pre-disposition in your genetic make-up to have something like this. I am a genetic disaster - my parents missed the bullets they so thoughtfully passed on to me! Is there any one else in your immediate and extended family that has a history of arthritis? I wish you well. DD

kaytepops

Hey, thanks for replying
Yeah, my mum said she had very mild psoriasis when she was younger but doesn't now...it may have be eczema in fact, she's not sure.
I think the main thing worrying me is that last time there was an obvious infection. I had a strange stomach upset a week before my knee started to swell up. But this time there was no infection as far as I am aware although when I finally get to see the rheumatologist this may turn out to be wrong.
I've been asked the usual questions by GP for signs of infection and doctor checked my throat but there was nothing out of the ordinary....and it started with shoulder pain, not knee swelling, plus my knees aren't that bad atm. It's my neck/shoulder and then left foot.
I took immuno-suppressants last time, they were the only thing that worked as it was going on for months with no sign of a let up. Maybe this does suggest psoriatic?

Annah

I was also diagnosed initially with reactive arthritis. I think it was because it occurred roughly a couple of weeks after having bad 'flu, but personally, I'm not convinced that was anything other than coincidence.

Some doctors suspect I have Psoriatic arthritis, but I've never had a confirmed psoriosis diagnosis. All we know is that steroids helped. Last time I had major skin problems, I was treated for eczema by the GP and not referred to a dermatologist - I should have insisted, but you live and learn.

For the moment, I keep getting the odd elevated ESR and other thingies I can't remember. They're keeping an eye on me, but confirmed diagnosis or not, there isn't much to be done at the moment, when its not flaring. Basically, stuff's happening in my immune system, but they can't pin it down. One of my doctors is a firm believer in things showing themselves if you're patient enough - and I suspect that's just happened to you.

Rotten luck on the arthritis flaring and ruining your Italy trip, but perhaps now the doctors will get it under control? Here's hoping.

woodbon

Hi, I'm really sorry that you are having such problems, but I'm also sure that you are not the only person. I don't know, either, much about the type of arthritis you have, but I'm sure a good doctor could help you.
How much longer are you staying away? I have nothing against the docotors you have seen so far, but the differences in culture and language will make it much harder to communicate and an English doctor may be able to explain what the problem is and/or send you to a specialist, to clere the problems up. Sorry thats my only suggestion! Love Suexxx

dreamdaisy

I had chronic eczema as a child, and then asthma developed: they came from my Ma's side of the family. The psoriasis I have now (courtesy of Pa) is very different: P is caused by the skin going into 'overdrive' and renewing itself every 3 - 4 days instead of the usual 28-31, hence the white plaques of 'dead' skin and the raw, immature skin under them. I have a wonderful patch of that on the inside of my left ankle.

Arthritis can start in many different ways. PsA is usually characterised by beginning in the small joints, e.g. fingers and toes, and often the nails become affected by thickening and ridging but it can also begin a larger joint, then after a while the parallel joint is affected too. That was my pattern in the first few years, now it's changing its behaviour. Each and every one of us is different in how it begins and how we are affected, there are no golden rules about it. This can add greatly to the frustration of everything. DD

Annah

Dream Daisy, I now believe (as do my doctors) that my last flare up of 'eczema', on the soles of my feet, was actually Palmoplantar Psoriasis (PPP). It was characterised by thickens plaques (disks) of skin which blistered and pealed - pretty nasty actually. I ended up with what looked like third degree burns on my feet. But the weird thing was, it didn't hurt half so much as it looked and it hardly itched at all, except at the edges when it was healing.

I've seen photos online that look exactly like my feet, and they're labelled as PPP, but my GP at the time was always reluctant to refer on to specialists so I never did get to see a dermatologist. I just accepted my GP's 'diagnosis' that it was a weird form of eczema. It was only later, when the joint pains began (in my fingers and toes) that I was kicking myself for not having pursued the matter further.

It's things like this that have caused me to lose faith in doctors, especially GP's. I have to fight a battle royal every time I need a referral, which is quite a lot given my pile of conditions. So for the moment, I'm just holding off until and if I get another flare up of my skin problems. Then I can get a test for psoriasis and finally put this question to bed, and then maybe I can go back to the rheumy for confirmation of a diagnosis of PsA.

At least my recent hip x-ray was clear.

dreamdaisy

I too get that, on my soles and palms. I think my scalp was covered in it when I began all this malarkey in April 97, but the GP then just called it sebhorrific (totally the wrong spelling, can't be bothered to check it) dermatitis. This was the same GP who told me that my fat knee would sort itself out. Yeah, right.

Doctors are the same as any other profession, you get good ones, bad ones, indifferent ones, careless ones, lazy ones, interested ones. Don't give up on all of them 'cos there are some good ones out there. We as patients do have to play an active part in managing our health - I am now sorting out my FA prescription as that appears to be beyond the ability of anyone at the surgery to read a letter from the hsopital and adjust my prescription accordingly. Twerps. Mind you, that letter also stated I take humira twice weekly! I was referred to dermatology by rheumatology when the P first appeared in October 06. I saw them in January 07 but have never been back. There's no need, really - and the coal-tar based stuff they gave me was horrible! The stuff on my ankle doesn't hurt - and I love peeling the dead skin. I know I shouldn't but . . . . . :oops: DD

AutoimmuneResearcher

Hi kaytepops
My AS is a form of reactive arthritis which comes and goes - I have read that there is a case that other forms of arthritis are also reaction to infection (for my AS it is Klebsiella bacteria that live normally in the gut) - for PsA the reactive trigger is purported to be Streptococus. RA research has pointed towards Proteus Mirabilis.

So a reactive arthritis could be any of the above where the auto-immune reaction tails off before a re-infection can happen. I have read that the infection for any trigger / reaction can sometimes be sub-clinical in that it would not be serious enough to need antibiotics.

Beyond that the difference between the different forms of arthritis are down to how our immune systems recognise the protein for the invading bug - the tissues in our bodies that have a similar protein (DNA message) as the bug will be attacked. If your interested google for Molecular Mimicry.

I hope you get some relief soon! Regards, Sean

Annah

Sean,
thanks for sharing that interesting idea, but I just wanted to point out that this is only a theory, and a controversial one at that. The actual causes of inflammatory arthritis aren't known and there are several theories. We need more research.

dreamdaisy

I thought an over-active immune system is known to be the root cause of PsA, Rheumatoid A and others and I am sure my PsA is the logical development of a life with eczema and asthma. Reactive A has a different trigger and responds well to anti-biotics. There is a strain of thought about treating inflammatory arthritis with anti-biotics: I must admit that I always feel better when I have a proper bug that involves anti-bios but that could also be because I'm off the meth and humira. I don't suffer with side effects per se with those but I do feel a great deal better in myself when I stop them even though I'm properly ill with something! DD

Annah

You can also have viral reactive arthritis, which doesn't respond to antibiotics. Even the bacterial form often doesn't react to antibiotics, since the bacteria that triggered it is often long gone, while the symptoms continue.

Plus other forms of arthritis (PsA, RA, AS etc) can all flare up in response to viral or bacterial infections, so sometimes they are misdiagnosed as Reactive A.

And sometimes other conditions, such as fibromyalgia or Ehlers-Danlos Syndrome can flare when a person has an infection, or a shock of some kind, and this too can be mistaken for Reactive A. And as there is no definitive test for Reactive A, or a lot of these other sero-negative joint conditions, you can never really be sure that that is what happened. Only in hindsight, really.

But the important thing, apart from taking doctors' advice, of course, it to keep moving (gently) throughout the flare, whatever is causing it, so your joints don't cease up and you lose a ton of muscle (as happened to me FWIW).