PsA Newbie

As a nurse practitioner and currently in case management working with children and young adults with complex medical needs, I often look first externally at my self with a clinical curiosity then the internal/emotional side catches up with a diagnosis. My recently diagnosed psoriatic arthritis (PsA) actually likely started several years back, as I put the various painful issues I’ve had that were named other things over the past three years into the perspective of inflammatory responses. I have very little skin manifestations of psoriasis, so this may be a factor in the delay in a diagnosis. It is a moot point as I move forward and have come to the awareness that the main joint manifestation of my PsA is clearly an inflammatory condition that is here to stay, but not to defeat.

Experiencing first symptoms of PsA

I first developed progressive pain and swelling in my right index finger metacarpophalangeal joint or mcp joint (i.e knuckle) almost three years ago. I work on the computer throughout my day, like I’m doing now typing this story and I thought the problem was an overuse syndrome from the mouse or gout. I saw my PCP and he did a uric acid test and sent me for xrays. All was normal. I did a course of an inflammatory medication and switched to a vertical mouse. If you’ve never heard of a vertical mouse, it is a mouse that is raised and fits into the hand. I love it and highly recommend it!

A couple of months went by with no relief, so I was referred to an orthopedic hand surgeon. He called the problem pseudo-gout (when labs and xrays are normal) and chose not to do a joint tap. He offered a steroid injection, which I accepted and within 24 hours I was pain for almost one year from the initial onset.

Recurring pain

Then one morning I felt a bit of soreness where I felt it one year ago and with my clinical sense highly suspected the problem was coming back. My wife will often tell me to ‘think positively’ when I offer a possible cause of a particular problem and will say something like ‘maybe you bumped it’. I’m not negative, just looking at myself as provider and patient and considering a cause.

I was right. The pain and swelling started again last November, nearly a year to date. I called the orthopedic office and they said with a second occurrence, I had to be evaluated by rheumatology. That took a few months and now the diagnostics were ramped up. X rays of hands, feet and sacroiliac (SI) joints and lab work. Everything was negative except something likely benign, but unsure, so an MRI was done and negative. Up to this point I was still thinking the swelling had something to do with repetitive overuse. I was not thinking of an inflammatory condition. It wasn’t in my not too far off retirement plan, but as I often say, ‘the only thing permanent is change’ and change it did.

Could it be psoriatic arthritis?

My rheumatologist brought up PsA as a likely diagnosis and gave me a 30 day prednisone taper. What was interesting about that was that the MCP joint responded a bit, but pain in both shoulders and my right foot subsided. It was a nice holiday. Shoulder pain and the right foot have been with me for some time with different dates of onset. The right shoulder started in the 80’s with a mild injury and has progressed over the years. Now there’s unexplained pain the deltoid muscle. The left started acting up summer before last and an improperly placed tetanus toxoid vaccination caused muscle, so I attribute the pain to that, but seems that is only part of the equation. The foot has a story as well, but to suffice it say, all of these occurrences are likely influenced and/or caused by an underlying inflammatory condition.

Accepting chronic pain

I’m convinced now I have PsA and I’m taking it in stride as my faith is strong and I know that patience and gratitude are key in accepting this change. Back in the 1990’s, I had a serious pain in the heel of my right foot. At some point, I decided that the pain and I had to co-exist and I pictured the pain like a side car on a motorcycle. We are attached and must travel together, so let’s figure how we can get along in a way that is positive and productive. That mental outlook and visual imagery was very helpful. It is useful again as I saddle up my motorbike and side car to continue on this journey.

Working on a treatment plan

This journey includes medication. I’m on methotrexate for nearly four months with Humira added about six weeks ago. No noticeable changes yet. I’ve also had my first round of Prolotherapy last week through my physical medicine and rehabilitation (PMR) provider. We’ll see how that goes. It’s worth a try.

I’m planning to also try a functional medicine approach through a functional medicine physician. With that said, I’ve leaned towards a more global view of our human existence. Many specialists today, as well as primary care providers, practice within various, sometimes rigid guidelines. They are evidence based, but sometimes restrictive. The growing knowledge about the gut microbiome is fascinating as well as the role of nutrition as medicine. I already ‘eat clean,’ but there may be more to discover about what I put into my system and the impact it may be having on my PsA, as well as my over all health.

Family keeps me motivated

I’m a relative ‘newbie’ in the PsA community, but I’m going to work with this problem to seek the most productive and satisfying lifestyle that I can have. We now have six grandchildren, all under four years old. I have another generation to help raise so my PsA is merely my new ‘side car’ and we will travel together.