.....

S-Z

SHAYNE
Hello, I guess I'm one of the new kids to the list. In the last few days I've been snooping around the archives and reading your e-mails. I must admit that I find the information very useful and I'm excited to have found group of people that can relate to PA. I'm 32 years old and my wife and I have just celebrated our 10th anniversary and our daughters first birthday.

I started getting small patches of Psoriasis around the age of 15. It was always on my scalp or hidden on my hips. Since it wasn't to visible I never really mentioned it to my doctor, instead I had always just tried different shampoos. Without much success I might add. About a year and half ago the P stared getting worse. It was spreading to a large area of my scalp, appearing on my lower legs, my lower back even in my belly button. About this same time my feet started really hurting and my little toe was swelled and turning a nice shade of red. It wasn't 2 months later that both wrists hurt, one thumb was so stiff I could hardly bend it. Both of my knees hurt with one swelled up like grapefruit. Time to go see the family doctor, which I don't enjoy doing. He took 55cc of fluid out of my knee, started me on naporcine and gave me some cortisone cream for the P. I was back 10 days later for another 55cc's. Then he asked if I was hurting anywhere else. He opened a can of worms with that question. The Dr. said that the pain and P could be related, but choose to send me to an orthopedic Dr. because the knee keeped swelling. The ortho doc took x-rays of hands, feet and knees and said there wasn't any damage yet. Both Dr.'s conferred and suspected PA. Over the last year I've been on (spelling?) naporcine, celebrex, arthroteck and some others I've forgotten about. This has been very discouraging and not to mention painful. One month ago I went to an RA. He did blood tests to get a baseline, I also showed negative for RA and Lupus. He increased my arthroteck to 150mg a day, which made no difference. Last week was my second visit and he started me on sulindac, which has reduced the swelling and given me back a lot of flexibility. However the pain has gotten a lot worse. I wonder if pain can increase as the inflammation decreases. This coming Sunday will be my first does of MTX. I have mixed feelings about this. On one hand I have hope for some relief, but on the other some of the side effects are pretty scary. My RA didn't mention anything about folic acid. Should I what till I see him again next month or call now before I start the MTX.

This got way to long so I'll wrap this up pretty quick. This whole PA thing has been pretty though to take since I've otherwise been healthy my entire life. It makes it hard to get on the floor and play with an energetic one-year-old when it hurts just to pick her up. My other joy is drag racing an old muscle car, which has had to be sidelined a lot this season. Enough complaining I'm not down for the count yet. Any advice would be helpful.

Thanks
Shayne
Dayton, Ohio

STEVE
A little history: I'm 34, I've had PA for about 5 or 6 years now, but it was only diagnosed 2 years ago. It first started just in my right index finger really painful at first, but eventually it settled down. The knuckle was just one big lump that wouldn't bend much but at least it didn't hurt so bad after a while. The best my Dr. could suggest was soaking it in epsom salts, the test for RA had come back negative, and there was no sign of psoriasis. Then about 2 years ago my finger started swelling again, and then my toes then my knee. I was running a low grade fever all the time. So I call the Doc, she says take ibuprofen, soak in epsom salts. Things just get worse so I call back and get an appointment in about 3 weeks. Meantime I'm trying to work like this cause I have one of those jobs where if you don't work you don't get paid, no sick days in other words.

Finally see the Dr., she can see something is wrong, she sucks about 60cc of fluid out of the knee, sends some of it, along with some blood, to the lab. Well, it's not gout and its still not RA. She sends me to an Orthopedic Dr. , who does some blood work. Guess what? It's still not RA! : ) He does give me a shot of cortisone in the knee and WHAM! Next day the knee is good as new. He sends me to a RD. It's another few weeks wait for that, by then I'm over the flare, and wondering if it's worth messing with. After all, I'm not hurting as bad now and this may never happen again. I have insurance, but it doesn't pay everything, and the x-rays and blood tests are starting to add up. Fortunately my dear wife threatened... Umm.. cajoled me into keeping the appointment..

The RD looks me over, notices I have a rash on my knee that's been there for about 6 months. He asks if I'm ever fatigued. OH BOY! Can't really remember the last time I wasn't tired. I'd just chalked it up to bad diet and lack of exercise. When I was really down on my self, I'd just figure I was just lazy!

Of course he diagnoses PA. Still wants more blood tests, x-rays, Starts me out on NSAIDS, I forget what , something real mild. He wants to start out with stuff that has the least side effects and work up from there. So we begin a pattern. Try something for about 6 or 8 weeks, go through a lot of nausea and bloating feelings till I get used to the stuff, then he puts me on something else because there hasn't been any change in my condition. DR: " Has the medicine helped your condition?" ME: "Well, Doc I'm not any worse but..."

Finally he puts me on Asulfidine. Explains the potential side effects, wants blood tests every 2 weeks (OH JOY). After about a month his office calls up, stop the Asulfidine ASAP, liver levels are high. So I wait a month, have some more tests, still high. He sends me to an Internist who want's yet more blood and a liver CAT Scan. " Hey Doc, those CAT SCAN thingies are EXPENSIVE! Can we wait and see what the blood tests say first?" Of course not! So here I go into debt again!

Tests all come back negative. I go to make an appointment with my RD and am told he's moved out of town. Or maybe out of state! By then I'm about broke, and thoroughly disgusted and swear off doctors for good!

Or at least until I have another flare up around the first of May. All the joints that were already affected are hurting like crazy, and the ring finger on my right hand is starting to go. So I call my Dr. to get a shot of cortisone in that joint, hoping that at least to save that one. This time she gets me in right away, I get the shot, absolutely sure that it will fix me right up. She also insists that I see another RD and by then I'm in complete agreement.!

So I find a RD that's on my HMO's list and make an appointment. Four weeks is the soonest he can see me. Wonderful! By then it's clear that the cortisone isn't having any effect at all, and I'm in PAIN and still trying to work.. So I call my Dr. to see if there's anything she can do to get me through till my appointment. PREDNISONE!!! YEAH!!! 60mgs the first day and the next day I'm feeling great! Then it's 50mgs the second day, and still doing good. Then 40, then 30 then 20 then10 then nice preddie all gone and Steve's hurtin' again and still 3 weeks to go!

So I call again. The nurse explains "Prednisone is a steroid, lots of side effects, the Dr. doesn't like to prescribe it any more than necessary. So on so forth..." But she relents, this time 60mgs for 2 day 50 for 2 40 for 2 and so on. But this time it doesn't seem to help quite as much, but still it's a lot better. Till I run out. By the time I call her up again I'm starting to feel like a junkie hittin' up his pusher for one more hit. "Come on man! I'm good for it! Honest!" This time it's 10mgs a day. And just enough to last me till my RD appointment. And with strict orders to see the RD! As if I had anything else in mind.

Jeeze! I'm writing a book here! Well, I've come this far, might as well finish.

Finally get in to see the RD. I've brought my records because I half expect him to want me to have all the tests all over again. I AM PREPARED TO FIGHT OVER THIS! He looks at my hands, asks a few questions. Diagnosis: PA! He looks at the records of all the tests. Looks at me, "What are all these tests for?" As if I had somehow been the one who ordered them done. "Here we look at the patient. The patient can tell you more than all those tests. THERE IS NO TEST FOR PSORIATIC ARTHRITIS ANYWAY!"

So, finally, here is where I stand: MTX 7.5mgs weekly, 10 mgs Prednisone daily until the MTX kicks in, 1mgs folic acid daily I guess for as long as I take the MTX. He said 4-6 weeks before the MTX starts working and I'm starting to wonder if I'll make it that long. : ( I had my first dose last friday, take my next dose tomorrow morning. So far no side effects. Does this mean I've lucked out and won't get any, or have I just not taken enough to know yet?

Anyway, I found this newsgroup the day after my visit to the RD, and it's been a lot of help just lurking around listening to everybody else stories. I've been on the net for about 3 tears now. Don't know why it took me so long to search the newsgroups for arthritis!

Since I wrote this my mtx has been upped to 15 mg, I found out I have diabetes, I've been off prednisone, and back on prednisone, and told by the Doc that I'll have to change jobs! Actually right now I'm doing well, a month ago I was doing terrible. I don't know how much of my current situation is due to the MTX starting to work and how much is due to the fact that I'm back on preddie.
Steve

TERRY
From: jdean@crocker.com
Good evening everyone! This is my first visit here and here is a little about myself.

I was first diagnosed with PA when I was 17. My dr. told me it wouldn't last. Well here I am at 39, still swollen and in pain like the rest of you. I've been on everything under the sun and nothing works or at least not for long. A big problem I have is my job. I've worked in a factory for the past 20 yrs., the last 7 on a 12-hr. shift. I repair machines and set them up for new orders to run. I have 2 sm. children and a full time job of housekeeping as all you mothers out there know.

I have just given up on my last meds. due to stomach problems and am going on will power alone. I was thinking about looking into vitamin suppliments for a change. Anyone been there or know where to start looking?
Terry


WENDY
Hi! My name is Wendy and I am 37. I live in Tennessee, am a wife and mother of two wonderful kids, ages 6 and 2. I developed P after my first child was born 6 years ago. These little spots broke out on my legs and I went to a dermatologist and he said yep, you have P. They looked at my nails (why I didn't know at the time......but boy do I know now) and said you have only moderate P. I felt bothered by my disease, but not really a big deal. The skin disease did worsen over the years, but still not too bad. My fingernails changed the most (pitting and thick and basically very ugly). They said that pregnancy may have triggered my disease, but would never know for sure.

Anyway, 4 years later, I had my second child and when he was about 4 months old and I was rocking him, my left knee strangely hurt. I wondered what in the world could this be. Well....I went to a GP, who gave me X-rays etc. I went to an orthopedic doctor who said I was fine after doing an MRI and drained fluid off my knee for the first time. I finally went to a rheumy and he very quickly said you have PA. ( I thought my grandfather has arthritis, not really a big deal. Was I WRONG! ) The rheumy said it is manageable. Just take some NSAID's and you'll be fine. I wondered.....pregnancy related again? Well, after trying several drugs, I finally landed with Naprelen for about 7 months.....it worked OK I guess.....but the PA was spreading. To my other knee, my elbows, my wrist, my back. And my blood count dropped (I developed anemia). He stopped the Naprelan and sent me to a stomach doctor this month. Took the upper GI test and no ulcers. I have just started the next level of meds now....I believe it is called sulfasalazine. The pain is awful and I take lots of Tylenol. I have a low grade fever many nights and just feel sick and tired.

But on a lighter note, I have read some of your stories and realize I am not yet in a wheelchair. I am thankful. I do wonder if this will eventually cripple me, if I will have to quit my job, if I will have to move away from my home with stairs, etc. But for now, I try to make it day by day and thank God that I am alive and with my family. I try to ignore my disease as much as possible......not sure whether that is such a good thing or not.

I look forward to talking with you all and learning more. My doc is OK I guess, but he doesn't like talking alot.

Wendy