What will happen

[benlytz]

Hello,
I am new to P as I have had it only for about 6 monts. Now my joints in my fingers and toes are clearly affected. What will happen when I go to the doctor. Do I have to go to a specialist, do I have to have many x-rays or other tests et.c.

[Fred]

Hello sorry to hear it's not getting any better, if your joints in toes and fingers are now affected do you mean they are painful and swollen, or just getting more psoriasis on them. ? If they are painful, swolen, red, and your nails are pitted and/or have lines running down them then it sounds like psoriatic arthritis.

Psoriatic arthritis looks like this on your nails.


If you think it is psoriatic arhtritis, i would ask your doctor to refer you to a Dermatologist. They may do X-rays but not usually necessary as a dermatologist will be able to tell if it is psoriatic arthritis by just looking at your toe and finger nails.

I'm not sure about Finland, but in the Uk and France your dermatologist will probably ask you questions related to your family as it has hereditary links (though no one in my family has it). You will probably be asked to strip down to your underwear so they can do a What is the PASI score my dermatologist uses ? and maybe a Dermatology Life Quality Index (DLQI). They will usually want a blood sample too, before deciding what is the best course of treatment for you.

Depending on the treatment they/you go for they may also do a check for tuberculosis (TB) if it's one of the Biological Treatments For Psoriasis, though they will probably recommend Methotrexate first.

Don't worry about seeing a dermatologist, it's the best thing you could do as once you build up a good relationship with them they can help you live with it. And if you look through other posts you will see there are lots of new treatments coming forward.

Another alternative that may be of interest to you is your Diet, it's not for all but some say it can help. Have a look through the Natural Treatments For Psoriasis if you want to have a go.

Caroline's thread may also be of interest to you: Dimethylfumarates and Psoriasis

I hope that has helped a bit and remember it's your body so only go for what you are happy with, good luck and please come back and let us know how it's going.

Regards.

Fred.

[benlytz]

Thank you Fred for your answer. Yes, it was psoriatic arthritis I was thinking on.

[Fred]

Thank you Fred for your answer. Yes, it was psoriatic arthritis I was thinking on.

You're welcome I hope it helps, I've had it for over 25 years now, there are others here who have it too and hopefully they will see this and chip in. Caroline is an active member with PsA so she may be able to offer some input too.

Forgot to mention this post which gives more info about Psoriatic Arthritis  

[Caroline]

hi Benlitz,

Fred already mentioned my name a few times. I am the one that usually disagrees with Fred, and he nows that .

I can only tell what my sequence was through the psoriasis-field, and what I think is logical. Basically I already have written it spread over several posts on this forum.

What I found out in the mean time is that PA (we in Holland call it Arhtritis Psoriatica), is an immune disease, so a dermatologist will not have a good view, as most of them have the, quite evident, focus on your skin. (I might later come back to this statement).
I had already a mild form of psoriasis for some years, mainly on my scalp. Then at a certain point in time, I, just like you, got pain in my joints and feet, they got all thick and painful. As I did not have a clue what it was, I went to the doctor and she pointed me through to the hospital department, where I went to an expert on feet and hands. He examined me, took pictures of me (of my feet and hands of course) saw some vague things and thought that bit of an operation chopping some stuff of my bones, would do the trick. Well, this did not sound very well, and combined with the type of guy it was, kind of a butcher, I said goodbye to him and went off.

Next station was another, larger hospital, with a reumatologist. Internal diseases, this time it was a nice young Belgian doctor. He also took pictures of me (no, Fred, again from my feet and hands), X-ray, I always wonder why these things have to happen two times, examined my feet and hands carefully. Loads of questions, also about my family. And he said to me, I know what you have. It's not reuma, but Arthritis Psoriatica.
O?!?!?, I said, and what does that mean? Can it be cured?
Well, he said, It's not curable, it can mean two things, either it will be livable or you will end up in a wheelchair. Point.
You can imagine that was an emotional and devastating moment. I was quite off the hook at that moment. But let me not bore you with that.
As my finger was extremely painful at that moment he gave me an injection in the finger with Prednisone, which after a few days released me of the pain, and made the finger a bit normal again. But the other problems remained, sore feet, sore hands, could not walk for a mile.
So a better treatment, more overall, had to be started. This was MTX, methotrexate, as Fred mentioned already. It is the normal "first" treatment for PA, when this does not work anymore they will later on go to biologicals..
This does not mean, that it is the right treatment of course. It is only in the protocol which doctors will follow like slaves.
So I got MTX.... In another post I explained already what it did to me, good luck finding this post, and after a few months I quit with MTX, it's the worst treatment in my opinion.

By luckily coincidence a friend of my mother pointed me at a doctor for internal diseases in Utrecht. I went to him, told him my story, he did not have to take pictures (...!.), and asked him if he knew a solution. And yes, he did he said, so he gave me a treatment with dimethylfumarates in a specific form.

And that was the solution for me. It's that easy. Amazingly I am the only one on this forum that uses this form, there is someone else that uses the pure form. All the others are on other medications.

Currently I can do sports again, unfortunately no running is possible, but spinning is now my favorite. And I can live a normal life. It is not completely over, but I have minor trouble, and the psoriasis on my scalp is also long gone now.
Fred already mentioned my posts on dimethylfumarates. You can read through them.

Currently my medication is prescribed by ... a dermatologist. , but... That is because the insurance will not pay if the medication is prescribed by a rheumatologist. This is caused by the fact that insurances are old fashioned and extremely 'behind' organisations, they still think that PsA is a skin disease, how off-the-road can one be.
Most of the dermatologists "know" that dimethylfumarates work against psorisasis but they will only prescribe it, if nothing else works. Why?.... It is also because they are probably stuck in old-fashioned education and very slow moving international research. DMF is not interesting because it is not patentable. You cannot earn very much with it.
I am lucky however with my dermatologist because.......... He has psoriasis himself.

Always prepared to give more information.
Caroline

[Fred]

So I got MTX.... In another post I explained already what it did to me, good luck finding this post.

I think this is the one Caroline is thinking of: MTX

[Caroline]

Oh, I forgot, indeed you need to go to a specialist.

[benlytz]

Thank you, Caroline, for a long and informative message.

[benlytz]

So, I went today to the doctor. Yes, I know I waited too long, but I dont like doctor's officies. You have to be there in time only to find out that you have to wait and wait and wait.....
I got Naproxen as a cure, 250 mg four times a day. After two weeks I can contact the doctor if I am not cured.
And so, what do you think will happen next?

[Caroline]

True, there is a lot of waiting in Doctors offices.

What will happen next?
Well naproxen is an anti-inflammatory drug, Wikipedia says: "Naproxen is commonly used for the reduction of pain, fever, inflammation and stiffness caused by conditions including migraine, osteoarthritis, kidney stones, rheumatoid arthritis, psoriatic arthritis, gout, ankylosing spondylitis, menstrual cramps, tendinitis and bursitis.[4] It is also used for the treatment of primary dysmenorrhea."

It is also marketed as "Aleve" against headaches.

It may help a little, you will not be cured, as soon as you stop, the PsA will be back again. If it helps against the inflammations, the you are lucky, but you will have to keep using the medication. Beware not to let the inflammations go too far, that may damage your limbs.

Caroline