Psoriatic without skin rashes

Holly28

Hello everyone,

I haven't yet received a diagnosis but my rheumatologist suspects I have psoriatic. I don't have skin rashes though and they've never been able to scan/test me doing a flare up.

I've started taking hydroxochloroquine and the other night experienced the side effect of uncontrollable laughter. Apparently 1 in 10 people do, could be worse!

Has anyone else started drugs before getting their diagnosis? It feels strange to still not be sure.

My right hand flares up and is very painful. Especially at the end of the day working at a computer - it seems silly to spend the hours where I'm not in pain working!

SharminB

Hi @Holly28

Welcome and thank you for joining the Versus Arthritis community 😊

Hopefully others here can share their experiences with hydroxychloroquine and starting treatment at different times.

As for the flare up in your hand, where possible try and take breaks to let your hands rest and maybe do some gentle exercises. If this is work you're doing in an office etc, you can have a chat with your manager or employer to make some reasonable adjustments for you (for example, short frequent breaks, ergonomic mouse/keyboard/mats). And this is protected by the Equality Act 2010. You can read more in the links below.

https://www.versusarthritis.org/about-arthritis/exercising-with-arthritis/exercises-for-healthy-joints/exercises-for-the-fingers-hands-and-wrists/

https://www.versusarthritis.org/about-arthritis/living-with-arthritis/work/

Do let us know how you get on 😊

Best wishes,

Sharmin - Mod

jamieA

Hi @Holly28

When I was diagnosed with PsA at 65 in 2020 the psoriasis I'd had since the age of 15 had almost disappeared in the last 15 years. I said this to the rheumatologist who told me I had PsA and he said it didn't really matter if I had visible psoriasis as any family history of psoriasis was enough for them to suspect PsA when my joints started to flare and swell. My father had psoriasis really badly and four of my siblings also have psoriasis. None of us had ever heard of PsA before I was diagnosed. The consultant who suspected I had PsA was not working as a rheumatologist but in 2nd line A&E. He had been a rheumatologist previously. I had attended hospital as an out patient for the 2nd time with a swollen left knee when he saw me and started me on sulfasalazine and naproxen then and there, getting a month's supply from the hospital pharmacy before I was discharged. I didn't see a rheumatology consultant for another month.

Holly28

Hi @jamieA thanks for your reply.

How did they eventually confirm psa? Did you have an ultrasound during a flare up? My mum has psa so I’m sure it is but it seems strange that my rheumatologist hasn’t said yes for sure.

What helps you with pain during flare ups?

I’m 28. Would rather it had held off for a bit longer!

jamieA

https://community.versusarthritis.org/discussion/comment/703779#Comment_703779

Hi @Holly28

I don't think there is any exact test that confirms PsA. The consultant who suspected I had PsA had been a rheumatology professor previously before having a career change and fronting up a new 2nd line A&E department - one that could only be accessed via referral by a doctor. I ended up seeing him 3 times and he was probably the person that has provided me with the most information regarding how they come to the diagnosis of PsA. As well as inflamed joints a big part of it is family history of either PsA or psoriasis, added to that is not having elevated levels of rheumatoid factor and anti-CCP but having elevated levels of CRP in blood tests. As well as that I was given an MRI scan of my lower back and when I asked why the medics said that the state of your sacroiliac joints which connect the base of your spine to your pelvis is an indicator of PsA. I've had ultrasouns of my hands, wrists and shoulders as well as x-rays of my shoulders, knees and foot and an MRI of my foot and shoulder. When I saw a rheumatology consultant for the first time he simply accepted the professor's diagnosis - he didn't even examine me - and was sure I had PsA. However I ended up being admitted to hospital on a number of occasions and since my rheumatology clinic is in a hospital that doesn't have an admissions ward it was to a different hospital. So I was seen by different rheumatologists. One said I had Polymyalgia rheumatica, another said I had only osteoarthritis and a 3rd said I had pseudogout - so I don't think it's an exact science. However I was put on the adalimumab biosimilar Amgevita in late July 2021 and my PsA is much more controlled now. I use elasticated knee support on my left knee and a tubigrip on my right and use capsaicin cream on my knees and shoulders when needed. I wear compression gloves to help my hands, fingers and wrists. I'm trying to avoid painkillers as much as possible as when I was taking opiod painkillers in 2021 it left me spaced out and with little memory of those times.

I hope you get sorted soon.