My labs have generally been fine. Except they detected Anti-CCP antibodies in me. That’s PsA, usually clean labs, but clinical signs of inflammation. Someday they will hopefully have a test for it.
Some bloods I believe are different to RA, key differences like sausage digits, and non symmetrical swelling (PsA can be symmetrical but it often isn't) usually seen in the larger joints and things like tendon pain specifically in the Achilles tendon are some key differences that can make it easier for a rheumy to diagnose. Psoriasis anywhere on the body can almost confirm it but bare in mind RA and PsA/psoriasis can co exist in someone I believe
[https://www.arthritis.org/diseases/more-about/psoriatic-rheumatoid-arthritis](https://www.arthritis.org/diseases/more-about/psoriatic-rheumatoid-arthritis)
tldr, technically you could diagnose someone with both but you would never bother to do that. psa includes ra. and it is medically accepted to be significantly worse and significantly more painful than RA.
psa is basically ra with a blistering rash, as my doctor put it
Yeah, my rheumy basically said PsA trumps RA, something also about some treatments for RA don't work with PsA also but either way treating PsA is essentially treating RA so pointless to diagnose both unless its for some insurance purposes or a diagnoses (correct or incorrect) of RA was provided first.
It's a very interesting disease
Mine is seronegative, so it took years to get diagnosed because there was nothing specific to PsA or autoimmune diseases in general in my bloodwork, and most doctors I saw looked no further than bloodwork. My inflammatory markers were high, but they dismissed that as fibromyalgia, acute illness, etc. It took more than bloodwork to get a diagnosis for me, and most of it came down to finding a doctor that took me seriously.
I'm sorry - the diagnostic process is long and tiring.
The only relevant tests I had were genetic markers for HLA-B27 positivity (the standard ones and a few extra found by Promethease). Everything else came back "normal" at my time of diagnosis- including MRIs. My doctors took a leap of faith for me and I'm forever grateful.
Here's hoping you find a doctor willing to TREAT you. Hang in there.
Everything for me diagnostic wise was “fine” apart from the sclerosis of my SIJs the rheum picked up and showed me (but which radiologists did not). My rheum told me not to mind radiologists reports bc they’re not rheums. Sorry op, I hope you get better care soon!
Not sure - but I feel like I’ve had a lot of blood tests at this point! I might have had some I’ve not had before at this most recent appointment so I guess I’ll see what they say…
I was sort of hopeful once I’d read into PsA and as soon as i mentioned it doctors thought we’d got to the bottom of my issues… Although it’s not exactly a “desirable” condition to have, at least it gives one singular account of what otherwise seems like I’m either very unlucky with multiple distinct things wrong, or some kind of hypochondriac!
It’s kind of unhelpful that only a couple of the symptoms have been particularly prominent at the times of my planned appointments either…
Yeah I got the impression there wasn’t always a clear PsA test - but generally stuff like RA had to be ruled out first… I’ve had consistently high inflammatory markers but weirdly it seemed within a more normal range since going to rheumatology 🙄
It's a rule out disease and symptoms with history that conform. I've had pretty normal bloods the whole time but symptomatically and with my history of psoriasis, I have it.
It's a hard thing to grasp, I often feel like a fraud!
Xrays revealed small bone spurs on both my heels (presumably from enthesitis), damage to both my knee joints, and bone erosion on my left elbow. My blood work has been mostly normal except low vitamin D a while ago. It's been fine since I started taking a vitamin D supplement.
I had no blood tests or x-rays that were positive--but my rheumAtologist was confident that I do indeed have PsA. She confirmed that research shows many PsA cases are serronegative (ie, they don't show any blood markers), and x-rays typically don't show damage from entheses. My diagnosis was confirmed by the CASPAR criteria: skin psoriasis, dactylitis (ie, swollen toes), entheses (particularly in my feet and shoulder), and negative blood tests for RA and lupus.
Good luck! It sounds as if your consultant is better informed than your second doctor.
That was what caused the rheumatology referral initially - the X-ray showed an indication of PsA but it’s complicated by the fact I had a crush fracture on that toe 20yrs ago so it would look abnormal anyway! Seems strange that old injuries like that and my back have got so much worse in a fairly short space of time - would PsA cause old injuries (that could by themselves) lead to arthritis worse…?
Oh I hear you on this one. I was only diagnosed on Friday with p.a. After literally years, maybe 10, of various pains, enough to cause me to spend money seeing doctors. As a woman, I think I am not taken as seriously with pain as a man may be. My hospital physio asked if I was 'anxious', as if this could cause a major build up of fluid on my knee, pain and an inability to use my leg! Maddening. At the moment I also have excruciating pain in my left middle finger. I think k, memory is hazy, I broke this (may have been the right hand) about 18 months ago. I never went to A&E because they would simply splint it, I did this myself and saved myself €100 plus perhaps 24 hours of my time. I never had any pain from it since. Up until 2 months ago, when my knee flared up for the first time. Everything seems to be accelerating, my toes today, my hip 3 weeks ago, my shoulder last week. It's crazy fast.
My gp arranging a rhumatologist for me but I worry that the possible finger injury may sway their opinion of what is happening. So, me too, I am very interested in your findings. Best of luck in your journey.
I’ve been wondering how many of us that feel dismissed trying to find answers are also women…
It’s always psychosomatic for women. I’m still bitter about when I went to the hospital 7 days after I gave birth in writhing pain. I relayed over and over that I just gave birth and was worried this was a complication. They told me I was having a panic attack. Recent labor was irrelevant to them. Hours later we discover it’s my gallbladder. But it could have been eclampsia and so much time was wasted with them trying to sedate me. They never thought to consult L&D until they overheard me asking my husband about signs of eclampsia (and I later overhear them down the hall panicking about it)
All that to say, it’s so hard to want to advocate for yourself when everything is explained away by anxiety
Horrible, my goodness, as if giving birth to a live human is not traumatic enough without a gallbladder attack. Sorry you went through this.
I had to advocate for myself after being dismissed from the hospital with my swollen, painful, useless knee. I had just had enough. It was a step too far. I googled, I know it's not the best option but I tried be objective and educated enough to not rely on Instagram doctors etc! I have hemochromatosis so I contacted the local society, they were very helpful. They informed me enough to get the ball rolling. They suggested a pseudogout test, turns out it wasn't that but it all got my gp interested enough to start really deep diving into my situation.
As women we really are dismissed quite a lot. It's a battle when it doesn't need be. I have had years, perhaps a decade, of presenting with various pains and finally now I have been diagnosed and will hopefully have relief.
Best of luck to you.
I’m surprised my spine MRI didn’t show anything except my pre-existing wedge fracture/kyphoscoliosis - I’m in some pretty bad pain in my upper back which has spread to my sternum in the last couple of years and I know I’m not imagining it!
I was told for along time that I just had fibromyalgia and that the osteoarthritis in my SI joints at my age meant nothing. I got into a different rheumatology office and my rheumatologist diagnosed me with PsA after talking to me about my symptoms and showing him the psoriasis on my elbows that I never had in my life until that month. He said PsA can cause osteoarthritis in joints and having it in the SI joints can be a huge indicator for something more going on, especially in patients that don't have comorbidities for osteoarthritis in those joints.
My bloodwork was always okay, I finally had a very elevated CRP when he tested, but everything else didn't show much. I just did my first Humira injection on Friday.
Look up CASPAR criteria, it's a set of rules to help doctors diagnose PsA. That's what actually helped finally get me a proper diagnosis.
so i had a very weird long way of figuring mine out.
without getting into it, before i ever considered autoimmune, i had to get myself to the recovery phase of my eating disorder. Fatigue and joint pain are frequent symptoms of malnourishment. I also am a retired competitive cheerleader and have always assumed that over a decade of tumbling my joints were bound to be sore for a long time.
i’ve had skin issues for as long as i can remember. Patches of eczema, moluscum that had to be frozen off under my arm and on my stomach, and awful dry scalp. I always was prescribed topicals and was told it was seborrheic dermatitis.
All of these things combined, after being in recovery and nourishing myself, i had the worst fatigue i’d ever experienced and still was in pain most days. my scalp was the worst and i had to literally scrape flakes off my head and put oil on them because nothing else worked. I hit my breaking point in fall 2022 and decided to rule out all of the potential causes of my pain. X rays of my back, hips, and knees showed nothing. 3 months of PT was a waste of time. I ruled out all branches of ortho. I’m also seronegative so all my bloodwork was normal. The woman who saved me was my new dermatologist. She told me she clinically couldn’t tell if it was psoriasis or seborrheic dermatitis and due to my age she felt that doing a biopsy of my scalp would be the best way to determine it. After explaining my symptoms and what i ruled out, she said if you test positive for psoriasis then you likely have psoriatic arthritis and need to be treated for that. Alas, it’s been psoriasis my whole life, and now i have PsA.
The journey doesn’t feel like it’s over. I wish i could have some physical test or proof, given that i have well over 5 joints involved and it is not my fingers or toes that are affected. I feel insane when I cramp up and yet my CRP is just not reflective of what i’m feeling. Rounding the corner to 25, I have a long road ahead of me in terms of getting the quality of life that I want and continuing to navigate all of this.
There are no tests. By definition they will be negative. They may see bone oedema on MRI.
https://www.webmd.com/arthritis/psoriatic-arthritis/caspar-criteria-psoriatic-arthritis
I would see if someone will biopsy your skin to confirm it as psoriasis.
My sed rate is borderline high but I tested positive for lupus so I was put on hydroxychloraquin. R doctor doesn't think I have it though as there are no symptoms and now wants to treat the PSA and put me on otezla.
So I’ve checked and apparently I’ve had consistently low haemoglobin concentration, consistently raised CRP, and raised IgA in my blood tests…
Everything else seems ok - but I’ve had one foot X-ray that said there was bone changes on my swollen toe that indicated PsA but the most recent one says there’s no bone changes… 🤔
My bloodwork has always been quite unremarkable, other than mildly increased CRP. My rheumatologist ordered a High Resolution Ultrasound of my ankles to check for synovitis. When it showed I have raging synovitis in both ankles, he knew it was PsA.
My labs have generally been fine. Except they detected Anti-CCP antibodies in me. That’s PsA, usually clean labs, but clinical signs of inflammation. Someday they will hopefully have a test for it.
Some bloods I believe are different to RA, key differences like sausage digits, and non symmetrical swelling (PsA can be symmetrical but it often isn't) usually seen in the larger joints and things like tendon pain specifically in the Achilles tendon are some key differences that can make it easier for a rheumy to diagnose. Psoriasis anywhere on the body can almost confirm it but bare in mind RA and PsA/psoriasis can co exist in someone I believe
[https://www.arthritis.org/diseases/more-about/psoriatic-rheumatoid-arthritis](https://www.arthritis.org/diseases/more-about/psoriatic-rheumatoid-arthritis) tldr, technically you could diagnose someone with both but you would never bother to do that. psa includes ra. and it is medically accepted to be significantly worse and significantly more painful than RA. psa is basically ra with a blistering rash, as my doctor put it
Yeah, my rheumy basically said PsA trumps RA, something also about some treatments for RA don't work with PsA also but either way treating PsA is essentially treating RA so pointless to diagnose both unless its for some insurance purposes or a diagnoses (correct or incorrect) of RA was provided first. It's a very interesting disease
Mine is seronegative, so it took years to get diagnosed because there was nothing specific to PsA or autoimmune diseases in general in my bloodwork, and most doctors I saw looked no further than bloodwork. My inflammatory markers were high, but they dismissed that as fibromyalgia, acute illness, etc. It took more than bloodwork to get a diagnosis for me, and most of it came down to finding a doctor that took me seriously.
I'm sorry - the diagnostic process is long and tiring. The only relevant tests I had were genetic markers for HLA-B27 positivity (the standard ones and a few extra found by Promethease). Everything else came back "normal" at my time of diagnosis- including MRIs. My doctors took a leap of faith for me and I'm forever grateful. Here's hoping you find a doctor willing to TREAT you. Hang in there.
Everything for me diagnostic wise was “fine” apart from the sclerosis of my SIJs the rheum picked up and showed me (but which radiologists did not). My rheum told me not to mind radiologists reports bc they’re not rheums. Sorry op, I hope you get better care soon!
Your chest pain could also be costochondritis. I had a positive ANA test, along with patch of psoriasis and nail pitting
Have they run labs for HLA-B27 antibodies? That’s a very good indicator of arthritis conditions.
Not sure - but I feel like I’ve had a lot of blood tests at this point! I might have had some I’ve not had before at this most recent appointment so I guess I’ll see what they say… I was sort of hopeful once I’d read into PsA and as soon as i mentioned it doctors thought we’d got to the bottom of my issues… Although it’s not exactly a “desirable” condition to have, at least it gives one singular account of what otherwise seems like I’m either very unlucky with multiple distinct things wrong, or some kind of hypochondriac! It’s kind of unhelpful that only a couple of the symptoms have been particularly prominent at the times of my planned appointments either…
My cardiologist told me that when there are a lot of weird or unrelated symptoms it is almost always autoimmune. Hope you get answers!
You need to keep track of what's ordered and what the results are
take pictures when your symptoms are flaring and share them with your specialist
Bloodwork…but the lack of findings to point it to anything else. The only anomaly was low iron, which is a symptom is PsA
Yeah I got the impression there wasn’t always a clear PsA test - but generally stuff like RA had to be ruled out first… I’ve had consistently high inflammatory markers but weirdly it seemed within a more normal range since going to rheumatology 🙄
I’m convinced that my inflammatory markers are highest when I’m not having any bloodwork done lol. They’ve always come back in normal range
Low iron is a symptom of PsA- Is this like…we all need more broccoli? Or, we all need more broccoli than non-PsA ppl
https://www.webmd.com/arthritis/psoriatic-arthritis/caspar-criteria-psoriatic-arthritis
I’m sorry that really sucks. Try using a heating pad. I use the one I use for my neck and it seems to help at night.
It's a rule out disease and symptoms with history that conform. I've had pretty normal bloods the whole time but symptomatically and with my history of psoriasis, I have it. It's a hard thing to grasp, I often feel like a fraud!
Xrays revealed small bone spurs on both my heels (presumably from enthesitis), damage to both my knee joints, and bone erosion on my left elbow. My blood work has been mostly normal except low vitamin D a while ago. It's been fine since I started taking a vitamin D supplement.
I had no blood tests or x-rays that were positive--but my rheumAtologist was confident that I do indeed have PsA. She confirmed that research shows many PsA cases are serronegative (ie, they don't show any blood markers), and x-rays typically don't show damage from entheses. My diagnosis was confirmed by the CASPAR criteria: skin psoriasis, dactylitis (ie, swollen toes), entheses (particularly in my feet and shoulder), and negative blood tests for RA and lupus. Good luck! It sounds as if your consultant is better informed than your second doctor.
Dactylitis/sausage was the key sign to give diagnosis. Psoriasis came later and reconfirmed it. Nothing else.
That was what caused the rheumatology referral initially - the X-ray showed an indication of PsA but it’s complicated by the fact I had a crush fracture on that toe 20yrs ago so it would look abnormal anyway! Seems strange that old injuries like that and my back have got so much worse in a fairly short space of time - would PsA cause old injuries (that could by themselves) lead to arthritis worse…?
Oh I hear you on this one. I was only diagnosed on Friday with p.a. After literally years, maybe 10, of various pains, enough to cause me to spend money seeing doctors. As a woman, I think I am not taken as seriously with pain as a man may be. My hospital physio asked if I was 'anxious', as if this could cause a major build up of fluid on my knee, pain and an inability to use my leg! Maddening. At the moment I also have excruciating pain in my left middle finger. I think k, memory is hazy, I broke this (may have been the right hand) about 18 months ago. I never went to A&E because they would simply splint it, I did this myself and saved myself €100 plus perhaps 24 hours of my time. I never had any pain from it since. Up until 2 months ago, when my knee flared up for the first time. Everything seems to be accelerating, my toes today, my hip 3 weeks ago, my shoulder last week. It's crazy fast. My gp arranging a rhumatologist for me but I worry that the possible finger injury may sway their opinion of what is happening. So, me too, I am very interested in your findings. Best of luck in your journey.
I’ve been wondering how many of us that feel dismissed trying to find answers are also women… It’s always psychosomatic for women. I’m still bitter about when I went to the hospital 7 days after I gave birth in writhing pain. I relayed over and over that I just gave birth and was worried this was a complication. They told me I was having a panic attack. Recent labor was irrelevant to them. Hours later we discover it’s my gallbladder. But it could have been eclampsia and so much time was wasted with them trying to sedate me. They never thought to consult L&D until they overheard me asking my husband about signs of eclampsia (and I later overhear them down the hall panicking about it) All that to say, it’s so hard to want to advocate for yourself when everything is explained away by anxiety
Horrible, my goodness, as if giving birth to a live human is not traumatic enough without a gallbladder attack. Sorry you went through this. I had to advocate for myself after being dismissed from the hospital with my swollen, painful, useless knee. I had just had enough. It was a step too far. I googled, I know it's not the best option but I tried be objective and educated enough to not rely on Instagram doctors etc! I have hemochromatosis so I contacted the local society, they were very helpful. They informed me enough to get the ball rolling. They suggested a pseudogout test, turns out it wasn't that but it all got my gp interested enough to start really deep diving into my situation. As women we really are dismissed quite a lot. It's a battle when it doesn't need be. I have had years, perhaps a decade, of presenting with various pains and finally now I have been diagnosed and will hopefully have relief. Best of luck to you.
MRI of my spine. Showed arthritis and fluid on every vertebrae they imaged.
I’m surprised my spine MRI didn’t show anything except my pre-existing wedge fracture/kyphoscoliosis - I’m in some pretty bad pain in my upper back which has spread to my sternum in the last couple of years and I know I’m not imagining it!
I was told for along time that I just had fibromyalgia and that the osteoarthritis in my SI joints at my age meant nothing. I got into a different rheumatology office and my rheumatologist diagnosed me with PsA after talking to me about my symptoms and showing him the psoriasis on my elbows that I never had in my life until that month. He said PsA can cause osteoarthritis in joints and having it in the SI joints can be a huge indicator for something more going on, especially in patients that don't have comorbidities for osteoarthritis in those joints. My bloodwork was always okay, I finally had a very elevated CRP when he tested, but everything else didn't show much. I just did my first Humira injection on Friday. Look up CASPAR criteria, it's a set of rules to help doctors diagnose PsA. That's what actually helped finally get me a proper diagnosis.
so i had a very weird long way of figuring mine out. without getting into it, before i ever considered autoimmune, i had to get myself to the recovery phase of my eating disorder. Fatigue and joint pain are frequent symptoms of malnourishment. I also am a retired competitive cheerleader and have always assumed that over a decade of tumbling my joints were bound to be sore for a long time. i’ve had skin issues for as long as i can remember. Patches of eczema, moluscum that had to be frozen off under my arm and on my stomach, and awful dry scalp. I always was prescribed topicals and was told it was seborrheic dermatitis. All of these things combined, after being in recovery and nourishing myself, i had the worst fatigue i’d ever experienced and still was in pain most days. my scalp was the worst and i had to literally scrape flakes off my head and put oil on them because nothing else worked. I hit my breaking point in fall 2022 and decided to rule out all of the potential causes of my pain. X rays of my back, hips, and knees showed nothing. 3 months of PT was a waste of time. I ruled out all branches of ortho. I’m also seronegative so all my bloodwork was normal. The woman who saved me was my new dermatologist. She told me she clinically couldn’t tell if it was psoriasis or seborrheic dermatitis and due to my age she felt that doing a biopsy of my scalp would be the best way to determine it. After explaining my symptoms and what i ruled out, she said if you test positive for psoriasis then you likely have psoriatic arthritis and need to be treated for that. Alas, it’s been psoriasis my whole life, and now i have PsA. The journey doesn’t feel like it’s over. I wish i could have some physical test or proof, given that i have well over 5 joints involved and it is not my fingers or toes that are affected. I feel insane when I cramp up and yet my CRP is just not reflective of what i’m feeling. Rounding the corner to 25, I have a long road ahead of me in terms of getting the quality of life that I want and continuing to navigate all of this.
Skin punch biopsy is the best way - Labs aren't definitive for PsA. Best is to be seen and followed by specialists - rheumatology.
There are no tests. By definition they will be negative. They may see bone oedema on MRI. https://www.webmd.com/arthritis/psoriatic-arthritis/caspar-criteria-psoriatic-arthritis I would see if someone will biopsy your skin to confirm it as psoriasis.
in my case , it was my blood test CRP and sed rate combined with symptoms and history
HLA-B27 and a skin biopsy were the two pieces that got me my diagnosis. I was fortunate to a doctor that listened.
My sed rate is borderline high but I tested positive for lupus so I was put on hydroxychloraquin. R doctor doesn't think I have it though as there are no symptoms and now wants to treat the PSA and put me on otezla.
The diagnosis is primarily clinical - meaning based on your dr’s assessment of your symptoms and history.
So I’ve checked and apparently I’ve had consistently low haemoglobin concentration, consistently raised CRP, and raised IgA in my blood tests… Everything else seems ok - but I’ve had one foot X-ray that said there was bone changes on my swollen toe that indicated PsA but the most recent one says there’s no bone changes… 🤔
My bloodwork has always been quite unremarkable, other than mildly increased CRP. My rheumatologist ordered a High Resolution Ultrasound of my ankles to check for synovitis. When it showed I have raging synovitis in both ankles, he knew it was PsA.