Osteo Arthritis and Psoriatic Arthritis

Agape
Agape Member Posts: 76
edited 3. Dec 2014, 04:48 in Living with Arthritis archive
Hi all, I have osteoarthritis in a few places now and my consultant feels that I also have psoriatic arthritis! I didn't reolise that you could have two different types!!! I have looked up on the Internet and recognise many of the symptoms of psoriatic arthritis but wondered if anyone could explain to me which is the worst one of the two to have! Also, should I be taking meds for this as a preventative or wait and see how things progress. :(

Comments

  • LignumVitae
    LignumVitae Member Posts: 1,972
    edited 30. Nov -1, 00:00
    Sadly, you can have many different types of arthritis! I currently have two in my collection which is enough for me :D

    Are you under the care of a rheumatologist? If so I would take their lead on meds. Generally, osteo is managed through pain relief and anti-inflammatories and then exercise. The other types of arthritis tend to be managed through drugs called disease modifying drugs, the aim being to start them early and hopefully reduce the disease to levels you can manage to live with. These are often used along side anti-inflammatories, pain relief and sometimes steroids when necessary.

    As for which is worst, that's probably a personal thing and difficult for others to answer. It depends what you have in which joint and the severity. I think osteo tends to be a slow burner and inflammatory arthritis' tend to have periods of acute discomfort if that makes sense.

    Hopefully, DreamDaisy will be along soon. She is our resident expert in these two in combination as she has them both and is super helpful and sadly knows her stuff all too well.
    Hey little fighter, things will get brighter
  • Agape
    Agape Member Posts: 76
    edited 30. Nov -1, 00:00
    Lignum Vitae, thank you for your reply. I am under a Rheumy and have been for a while, it was my Rheumy that said that I had Psoriatic Arthritis on top of my osteoarthritis and wanted to put me onto Methotrexate. I looked this drug up and really didn't think that I was ready to take this step, but am starting to worry that I could be doing myself some harm by not looking into/taking some kind of preventative med, it's such a hard decision to take. If I could manage on Co-Codamol, would this be ok? Sorry to keep asking questions, but I just don't know what to do. :roll:
  • LignumVitae
    LignumVitae Member Posts: 1,972
    edited 30. Nov -1, 00:00
    Hi Agape,

    Please don't apologise, we're here to support each other - I often use the forum to ask questions and sound out people's opinions.

    First of all, don't fear all the things you read from google! Meth has a huge list of POTENTIAL side effects. They are potential and whilst on meth you have regular blood tests that are monitored, you have a flu jab and before you start a chest xray all of these are to check that the medication is suitable for you. The second anything changes in those tests your meds are reviewed. I've been on meth since 2007 and it has been a wonder drug for me, the worst side effects being mouth ulcers and hair loss both of which were combated by increasing my folic acid (you are prescribed that along side meth). You do lower your immunity but generally, that just requires a bit of care on your behalf to avoid potential risks. Good food hygiene, avoiding people with bugs and good hand washing tends to be all I do on that front.

    Co-codamol will relieve pain but it won't alter the course of psoriatic arthritis. That is why disease modifying drugs, like meth, are prescribed. Disease modifier tend not to halt inflammatory arthritis but they do tend to slow or alter it's progression.

    What is it about meth that scares you? Is it the meth or the fact you have the arthritis that you are struggling with? It is a lot to take on board, particularly when you thought you had one arthritis and then find out another one has tagged along too.

    LV
    Hey little fighter, things will get brighter
  • stickywicket
    stickywicket Member Posts: 26,325
    edited 30. Nov -1, 00:00
    Agape, your post rang a distant bell so I had a look at previous ones and I think I can say things no more clearly now than I did then so I'll just copy my reply in here :)

    Basically, there are two forms of arthritis, OA and the auto-immune versions. RA is an auto-immune form of arthritis but by no means the only one. Another auto-immune form is Psoriatic Arthritis (PsA) and, if you already have both an auto-immune disease plus psoriasis, I think it's important that you get on one of the DMARDS (Disease Modifying Anti-Rheumatic Medications). Hydroxychloroquine is just one. There are several others, and many on here have to experiment a bit before finding one that suits them. One man's meat....etc etc. I had a very scary reaction to leflunomide but it didn't stop me trying methotrexate (which has been very successful for me) and I know others have no problems with leflunomide.

    OA will always get worse. We can hold back its worst excesses to some extent by a good diet (Well done on that front ) exercise, distraction and pain relief but it will progress over time.

    The damage from auto-immune types of arthritis can be held back by DMARDS but only rheumatologists can prescribe them. It's not that your GP is 'useless'; it's just that he doesn't have the specialist training needed to deal with auto-immune diseases. Asking him to do so is a bit like asking him to perform knee replacement surgery. He doesn't have the training.

    I do understand your reluctance to take 'strong meds'. I think most of us start out like that. But auto-immune types of arthritis are strong diseases and they require powerful meds to hold them back. Although methotrexate helps me enormously these days, it wasn't available when I was first diagnosed and, as a result, I have all the characteristic twisted joints in hands and feet. You are probably still in a position to avoid that. If your rheumatology appointment isn't until January, I think you should ask for it to be brought forward and have a good chat with your rheumatologist about your joints and psoriasis so that it can be determined how much is OA, how much might be auto-immune and what can be done about the latter. You might not want strong meds but, if the rheumatologist suggests them, I'd be guided by that.
    http://arthritiscareforum.org.uk/viewtopic.php?t=40426
    If at first you don't succeed, then skydiving definitely isn't for you.
    Steven Wright
  • dreamdaisy
    dreamdaisy Member Posts: 31,557
    edited 30. Nov -1, 00:00
    Hello, my problems started in April 1997 - I didn't begin any medications until February 2002 but even then medical opinion was divided as to what was wrong with me. My first DMARD was sulphasalazine and over the years I've given methotrexate, leflunomide and cyclosporine a go, plus the big-guns of infliximab, Enbrel and humira. Currently I take injected meth, injected humira and tablet sulph: although I do not feel any physical benefit I know that this trio has slowed the progression of the PsA.

    My OA was diagnosed in April 2012 and has come about as a result of the joint damage caused by the PsA. I have around 40 or so affected joints, the majority with PsA and others with both. Of the two I much prefer the OA because it is much more honest in how it presents and affects me, the PsA is a sly one and has far more-reaching effects.

    It is entirely possible to have an auto-immune arthritis plus OA - welcome to a rather exclusive club. :( DD
    Have you got the despatches? No, I always walk like this. Eddie Braben
  • Agape
    Agape Member Posts: 76
    edited 30. Nov -1, 00:00
    Hi Stickywicket, thank you for you reply. Although I have a high RF I am told that I don't have RA, I am only going on their word as I trust you can have a high RF result and not have RA! As you will note from my previous posts I do have Sjogren's Syndrome; Psoriasis; Osteo Arthritis and at my last apt was told I have PsA. I take 600mg of Lyrica a day and Co-Codamol when I am in pain. I have tried Hydroxycloriquin but had a very bad reaction to it and had to stop.
    I am under a Rheumatologist and she is the one prescribing my meds. :) I will take yr advice and will try to make an apt with her to review things in a clearer way, trouble is she is soon moving on so not sure that I will be able to get an apt and I wonder if I shud wait and go over this with whoever takes over her position as they may have other ideas!

    Can I ask, how can they test for how much is OA and how much auto- immune? If you can let me know I will ask at my next apt. I only really considered that my SJS was the auto-immune. Thank you for yr help.

    LignumVitae - Just an add on to yr reply. Yes, my Rheumy did mention that I wud be monitored whilst on Methotrexate, so this wud be a safeguard, my worry wud also be if this med wud be bad for me long term. I do suffer from hair loss already, the thought of more wud be horrible, but I guess it's swings and roundabouts. I think that I will have to take more Co-Codamols when in pain, but from these replies, I see clearly that the pain killers may sort the pain but won't deal with the progression of either OA or PsA, which scares me and as silly as it sounds, I honestly hadn't thought of this! :roll:

    Thank you for yr help. :)
  • Agape
    Agape Member Posts: 76
    edited 30. Nov -1, 00:00
    Hello Dreamdaisey, sorry I missed you off of my reply.

    I am so sorry to hear how PsA and OA has affected you. One question that comes to my mind is... Is there a sure test for PsA? And if so, would I be able to ask for this test to guarantee that I have this? I truly think I must be kidding myself with this PsA thing, but I can't seem to believe what's happening to me. What would be 'some' of the first signs of PsA?

    Take care and I hope you have a good week.

    A
  • dreamdaisy
    dreamdaisy Member Posts: 31,557
    edited 30. Nov -1, 00:00
    There is no sure test for any of us. I was classed for a few years as having some form of auto-immune inflammatory arthritis - I was sero-negative but my inflammation markers were always high, anywhere between 50 to 170. The only combination of meds which has really reduced those is my current combination, now they are always below five or sometimes too small to measure, this is how I know they are working.

    When my troubles began in 1997 I had what I now know to be extensive psoriasis on my scalp but it was never diagnosed as such. After years of eczema I was used to itchy and scaly skin so it was no big deal, plus I couldn't see it! The medical penny dropped in October 2006 when my skin helpfully obliged with a blast of pustular psoriasis on my palms and soles. I also now have some stubborn patches on my ankles and on some of my scars. The label changed, the meds didn't. The sulphasalazine helps to keep my skin clear but it's never touched anything to do with the joints. I have a friend with PsA who's condition is under complete control with just four tablets per day - he still grumbles though!

    I am sure I would be in a far better situation now if I had been taken seriously by my then GP and seen a rheumatologist long before I eventually did (courtesy of the physios at the local footy club, believe it or not, they were the ones who referred me in November 2000). Even then the first one told me I was orthopaedics problem so I lost another year being bounced between the two departments. After a lifetime spent taking medical drugs I never hesitated about starting any of the ones I have tried but if one is new to all of this then it must be scary. I read the side-effects leaflet once, have a giggle then put them away only to be consulted if something doesn't feel right within me. I always assume I won't have any troubles and I usually don't: the mind is a powerful thing and we can 'talk' ourselves into feeling things which aren't actually happening. DD
    Have you got the despatches? No, I always walk like this. Eddie Braben
  • stickywicket
    stickywicket Member Posts: 26,325
    edited 30. Nov -1, 00:00
    Right, let's try to get this a bit clearer. OA is one type of arthritis. It can arise for many reasons and none but, like DD, I have it because my auto-immune arthritis wasn't able to be treated with the correct medication (DMARDS) early enough. My auto-immune arthritis is RA. I know that yours and DD's is PsA but both types are dealt with, essentially, the same by rheumatologists ie with DMARDS. Sulphasalazine, methotrexate and hydroxychloroquine are three such. I get by very well indeed on a combination of methotrexate and hydroxychloroquine.

    I don't think there will be any exact answers as to how much of yours is PsA and how much OA. In fact, it seems to me to be a bit of a red herring. What you need is to slow down the progress of the PsA by use of DMARDS. The OA can't be slowed. It will go at its own pace and your GP will deal with it, prescribing pain relief and possibly anti-inflammatories.

    I can understand your fear of DMARDS. Many people share it especially when new to them. Oddly, people fear the meds more than the disease. Hair loss is not guaranteed. Most people don't get it. In fact, most people don't get any of the side-effects. But, even if some hair loss occurred, isn't it better than uncontrolled PsA?

    Getting more and more dependent on cocodamol, or other pain relief, is no solution. If I were in your shoes I'd want to get on another DMARD asap. When are you next due to see the rheumatologist? It doesn't matter if the consultant changes. Another will take over and have your notes. It probably seems quite complex to you but they deal with these changes all the time.

    Long term? Sometimes the meds stop working, sometimes they bring their own problems. Sometimes we have to move on to others. But , long term, without DMARDS, your PsA will get worse. That's a fact. It really does need to be dealt with.
    If at first you don't succeed, then skydiving definitely isn't for you.
    Steven Wright
  • Agape
    Agape Member Posts: 76
    edited 30. Nov -1, 00:00
    DD, what a road you have trod, I can't believe that it took so long for you to have a clear DX. You are right when you say that the mind is powerful, I do sometimes worry that I might get some of the bad side affects but I need to look on the positive side and remember that my health issues will improve with DMARDs. Thank you for sharing your experiences with me.

    Stickywicket, thanks for explaining things, I understand better now. I am hoping that I will get an apt with my Rheumy before she leaves but I am not sure that this will happen. I am at present trying to call and push for a date. This has all arisen because my Rheumy looked at my symptoms and said she 'thought' that I might have PsA, this is why I had so many questions, she was convinced enough to suggest Methotrexate.

    Having said all of the above, can I ask one more question… Up and until my 5o's I had Psoriasis on my elbows and knees, my elbows were so itchy that I would scratch them until they bled, I know I shouldn't have scratched them but this was the only way to relieve it. Psoriasis would creep further up my elbow/arm. Then all of a sudden it disappeared, I do have what I think might be Psoriasis on my toes, horrible. Does Psoriasis disappear and reappear somewhere else? Weird!
  • dreamdaisy
    dreamdaisy Member Posts: 31,557
    edited 30. Nov -1, 00:00
    Yes, it can. Psoriasis is caused by the skin renewing itself within a matter of three or four days as opposed to the usual three-to-four-weeks-or-so of those who don't have it. My favourite flaky sites are the insides of my ankles and the outsides of my knees but it also occurs on my various scars and I have another form on my soles and palms. I recognises that I am fortunate in that it's pretty mild.

    There can be a delay in diagnosing any form of auto-immune arthritis (there are many of them, it's complicated) but it seems to me that now more people are being referred more quickly by their GPs to 'those in the know'. As I said I always presume I'll be fine with the meds and usually I am. When I wasn't I hadn't a clue that things were amiss - this is why one must be conscientious about getting bloods done, it was my bloods that showed that things weren't too good. DD
    Have you got the despatches? No, I always walk like this. Eddie Braben
  • stickywicket
    stickywicket Member Posts: 26,325
    edited 30. Nov -1, 00:00
    What's even weirder is that inflammatory arthritis can disappear too, only to reappear later. In the early days I had some 'free' spells. That all changed after my first son was born.

    I hope you can get an appointment with the rheumatologist you've seen before but, if not, I often find a fresh pair of eyes gives a new insight to things. Good luck :D
    If at first you don't succeed, then skydiving definitely isn't for you.
    Steven Wright
  • northender
    northender Member Posts: 10
    edited 30. Nov -1, 00:00
    Hi I am new here and just want to ask a few questions.
    I have had problems with my back for years (been knocked off bike twice 2nd time resulting in a fractured pelvis and had a nasty fall, all times striking the base of my spine) and in the last few years occasional problems with my groin and sciatic nerve. I recently visited the doctor and due to not paying attention when I was younger (like you do). I found that in 95 they found osteoarhritis in my spine along with degenerative disc disease.
    Which explained a lot
    I had been oblivious for nearly 20 years, just thought I was getting old.
    I have always avoided doing anything that aggravates it, am I doing the right thing? So long as I am mobile I'm ok, but if I stand for long periods on one spot, eventually I start to seize up. Is this common? This last few months I have been less mobile at work and I have had problems with my ankles, knees, and now groin , is this common I am not at a point I need painkillers even though I have been in excruciating pain in the past. I want to manage it and take more care of myself as I don't want to be in a lot of pain when I am older. Any tips on managing it will be great. The strange thing is, at work they cant understand how I can lift something heavy, but can't do a lighter job, because last time I did it, I was in pain for three months.
  • stickywicket
    stickywicket Member Posts: 26,325
    edited 30. Nov -1, 00:00
    Hi there northender :) I think you've managed very well indeed if you've had so many problems for so long. Probably your general fitness levels have helped. Keeping things moving without putting too much strain on dodgy joints is ideal. (I'm not sure about the heavy lifting, though.) You might find some useful info here: http://www.arthritiscare.org.uk/PublicationsandResources/Listedbysubject

    We're not docs and can't tell you the reasons behind your latest pains. It's true that arthritis can move into other joints once it has a toe-hold but, equally, if you are walking a bit awkwardly due to pain in one site, it can create what's called 'referred pain' in another. Groin pain is often associated with hip problems though.

    I've had RA for many years and OA for a few less and I always find that, no matter how hard walking is, standing is harder.

    It might be worth having another word with your GP just to tell him / her what you've told us. X-rays, or a scan, might help to show whether there's anything happening in your ankles, knees, etc. If not, and yours is referred pain due to how you're walking etc, a referral to an orthotist might help you.

    P.S. Would that be Preston North End er?
    If at first you don't succeed, then skydiving definitely isn't for you.
    Steven Wright
  • northender
    northender Member Posts: 10
    edited 30. Nov -1, 00:00
    thanks stickywicket

    and yes PNE through and through
  • northender
    northender Member Posts: 10
    edited 30. Nov -1, 00:00
    a bit more advice please.

    spoke to H R at work and asked if I could be more mobile, as my job is not a mobile as it was, due to moving floors and not being allowed to get what we need to do a job. so walking round a lot less, plus the job I do now I am stood on one spot for long periods of time. There are three jobs I can (and have) done, now I am confined to the one, so I asked to mix all three.

    I was asked a couple of months ago to do a job which I KNOW will cause me problems, but my supervisor can't seem to grasp this, so I went to see the doc, which is when I discovered the reasons why it caused me discomfort. Even after seeing a doctors letter, they still question me, and comments like "why didn't you take redundancy if you knew you had this problem?" ( I didn't at the time) Maybe I should get work somewhere else, and today "If you want to be upright and mobile have you ever considered a job as a cleaner!" are they allowed to do this?
    I ended up walking out of the office.
  • dreamdaisy
    dreamdaisy Member Posts: 31,557
    edited 30. Nov -1, 00:00
    Hello, I missed your first post as I've been busy over the past few days. I presume you have OA (unlike the originator of the thread who has two kinds of the disease) and everything that you have described is par for the course. Any form of arthritis is degenerative and progressive but one of the problems with OA is its sheer ubiquity: there are between 8 - 10 million arthritics in the UK, the majority of whom have OA, so you're not alone. The trouble is that the remaining few millions have absolutely no idea what having arthritis entails so we can find ourselves on the receiving end of insensitive and stupid comments. I prefer to move (although I don't do that very well) and standing still is an absolute no-no. I have two kinds of arthritis and around forty affected joints, all useful ones. :wink:

    It might be worth your reading some of the threads on the Benefits and Working Matters board on here, that's where work-related issues are dealt with. Your employer has a duty of care towards you so your first port-of-call maybe contacting the CAB, they know their stuff and will be able to advise you of your rights etc. I was self-employed so never had to deal with this. It may an idea to post a new thread under your name as more people will spot you and, hopefully, reply! I wish you well. DD
    Have you got the despatches? No, I always walk like this. Eddie Braben
  • dreamdaisy
    dreamdaisy Member Posts: 31,557
    edited 30. Nov -1, 00:00
    Hello again, Agape, we're a few days on now: how are things going? DD
    Have you got the despatches? No, I always walk like this. Eddie Braben
  • stickywicket
    stickywicket Member Posts: 26,325
    edited 30. Nov -1, 00:00
    Workplaces and work colleagues can be very casually cruel. I'm pretty sure they have to make all reasonable adjustments for you but some are better than others at doing so.

    DD's right that you'd get more responses on here if you started a new thread as the header of this one doesn't give us a clue as to what your own difficulties are. CAB are a good idea. Our own Helplines could probably tell you more too about what your rights are. Or this site might be useful https://www.gov.uk/reasonable-adjustments-for-disabled-workers Good luck. It's not easy fighting for one's rights.

    (Preston North End? I used to be keen on Leeds Utd but.......... :roll: )
    If at first you don't succeed, then skydiving definitely isn't for you.
    Steven Wright