Should GP have been more on the ball?

alexander1

I have been diagnosed as having psoriasis arthritis after 5-6 years of symptoms Pain killers, 2 hip replacements steroid injections And radio frequency ablation ( sadly didn’t work) I have had skin psoriasis all my life and when the GP diagnosed osteoarthritis they didn’t connect the symptoms and history so treated me for degenerative arthritis. Having spoken to the rhumatoidologist I was referred to in Dec 21 and saw yesterday he has put me n steroids and immune suppressants

My orthopaedic surgeon is now saying I need to have both shoulders and probably both knees replaced and pain clinic have said the spine is knackered across

I asked if I had been referred to him 5 years ago would I be in a better position with my joints and spine and the simple answer was yes

NHS are great service but really frustrated I have had 5 years and now joints and spine are knackered and the constant pain

soz about complaining

[Deleted User]

Hi @alexander1, welcome to the online community! It's lovely to have you here.

In sorry to hear that it took so long for the right diagnosis to come your way, you're justified in feeling frustrated. No need to apologise for complaining, that's what we're here for after all :)

Hopefully the steroids and immune suppressants help, do let us know how you get on with them. I'm sure there are people here who have had the surgeries that have been suggested so if you have any worries or questions please do ask.

Best wishes, Sarah (moderator)

stickywicket

Quick answer - yes. But.....

I was diagnosed (RA) before modern DMARDS came along. I needed my first joint replacements 20 years later (knees). 5-6 sounds like an amazingly swift deterioration. Now, 60 years on, albeit with methotrexate and hydroxychloroquine for the last 22 years, my spine is still OK. I've had two hip and three knee replacements. Nothing else.

I know everyone's disease progresses at different rates but I do wonder if you did actually have OA as well as PsA when you were diagnosed. That would complicate things. Most of us with inflammatory forms of arthritis get the OA as a result of the inflammatory form but sometimes people come on here who have had OA for some time and only just acquired RA, PsA or another inflammatory form.

Given your own psoriasis and family history, surely you should still have been referred to a rheumatologist if only as a belt and braces job. Why not talk to your GP and ask why he didn't put two and two together. This doesn't have to be aggressive or confrontational. It's a reasonable question. It might be that x-rays showed considerable OA right from the start but, even so....

I guess what I'm saying is that, in my view, the 'what ifs' don't really help. Yes, the GP might have been wrong but you have to live in the present and that's hard enough without feeling that, maybe it didn't have to be like this. I hope the DMARDS will help a lot.

DorothyParker

Sorry to hear this. I have psoriatic arthritis with axial spondyloarthritis, degenerative spinal disease and some osteoarthritis, and I know how hard the diagnostic process can be.

It's hard to say whether your GP should have known. I read somewhere that anyone with skin psoriasis should be assessed annually for signs of inflammatory arthritis, but I imagine that doesn't really happen. But in an ideal world, a GP on the ball would have joined the dots, yes. I didn't really have any skin psoriasis, I had some mild nail psoriasis but didn't even know what it was until a rheumatologist noticed it.

I have great GPs generally. I understand how how difficult their job is, but I get frustrated by how little they know about inflammatory arthritis generally, or the medication we take for it, when it's really not that uncommon. I found one GP in my practice whose father has psoriatic arthritis and felt like I'd hit the jackpot. It makes such a difference to have a doctor who understands it so I try to see him about anything arthritis-related, even though he's not my normal GP.

In my experience GPs sort of assume you're being looked after by your rheumatologist for everything joint-related so don't take much interest, while the rheumatologist expects the GP to look after you between appointments or for the degenerative non-inflammatory stuff - so you end up caught between two stools, getting less care than you would if you didn't have a chronic condition.

I hope the medication works out for you. Getting any diagnosis like this takes some time to get used to. I could say move on and don't worry about it, but I didn't take my own advice and spent a lot of time angry about what happened under rheumatology.