Rashes, joint pain, and frustration

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cmc2121
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Hello everyone.  I'm hoping to get a bit of advice/input on whether or not what I'm experiencing might by psoriasis and psoriatic arthritis, because overall doctors have not exactly been helpful.  Since 2011 I've had rashes on and off (I'd say present 85% of that time).  The rash is red, extremely itchy, and flaky, but not silverish like I see in photographs of psoriasis.  It usually occurs in circular blotches on my lower legs, from my knees to my ankles, but has also occured on my lower back, my armpits, and the back of my neck around hairline.  Doctors (GPs, not dermatologists) have misdiagnosed it as poison oak contact dermatitis (I no longer work around poison oak but the rash persists), scabies, and the most recent diagnosis is eczema.  Changing soaps, laundry detergents, etc doesn't help, and I use all natural products anyway that are free of many chemicals, dyes, and perfumes.  Prednisone, cortecosteroid shots, and triamcinolone make the rash go away, but it's very short-lived and the rash is typically back within a few days of stopping use.  When my rash gets really bad, a lymph node in the back of my neck swells up and becomes tender.  Even when the rash disappears for a while, the skin on my legs is still itchy (sometimes my scalp is too).  Does this sound like psoriasis?  Does it need to have that silver scale to it?

In addition to the rash, I've been dealing with severe fatigue since late 2013, dry eyes (to the point of blurred vision), joint pain on and off since early 2014, and lower back/sarcoiliac area pain since early 2015.  Lately the joint pain has gotten worse, has become mostly symmetrical, and is affecting multiple joints at a time.  The joints affected are my knees, ankles, elbows, wrists, sometimes shoulder & neck, and possibly my hips (I can't actually tell if it's back pain or hip pain).  However, I rarely have any indication of swelling in my joints--occasionally they are tender or sometimes my toes swell, but that's about it.

I finally found a doctor the other week who actually listened to me, so we ran some blood work for ANA-IFA, ESR, and CRP.  ANA-IFA came back positive with a titer of 1:160 and speckled pattern.  ESR and CRP were normal (I was also taking 15mg meloxicam at the time and am not sure if that would have impacted the inflammation results).  Following the positive ANA, the doctor ordered an autoimmune cascade, sent off to a commercial lab.  The lab ran an ANA-EIA analysis, and the result came back negative (0.2), so they didn't complete any further tests in the cascade.  My doctor has decided based entirely on the second test result that I don't have an autoimmune disease and that everything is in my head (I have a history of social anxiety, so most doctors tend to stereotype me and just lecture me on seeing a counselor).  I know this is not in my head--something is wrong with me and I have no reason to be making this up (I hate attention and I dislike going to see doctors).  It's impacting my life, my relationship (my fiance doesn't seem to believe me either), and my work.

I think the second test was faulty (scientific literature suggests that ANA-EIA tests my have a hard time picking up antinuclear antibodies with a speckled pattern, and literature also suggests that commercial lab test can be highly variable and unreliable; IFA is also supposedly the gold standard).  Right now an autoimmune disease is the best lead I have on figuring out what is wrong--I fit the symptoms and think that RA, PsA, or MCTD are possibilities.

Does anyone have psoriatic arthritis or rheumatoid arthritis without visisble swelling of your joints?  Do you think my age--27--might affect how much inflammation there might be?  Do you think my symptoms fit psoriasis and/or psoriatic arthritis?  Thanks.

0 likes, 11 replies

11 Replies

  • Posted

    Hi sorry to hear you are not feeling to good, your story seems a bit similar to my own i have psoriasis which I have suffered for a long Time over the last year I have beginning to have joint pains which started in my right wrist.

    Now has progressed to both wrists my neck, both knees, ankles, lower back and have stiffnes all over with most pain more at night.

    I have had no diagnoisis although at first the doctor thought it was PA, but blood test and rheumatlogist says otherwise.

    I have also been told it was In my head as i suffered from prior depression, I use cocodamol for pain and voltarol cream which take the edge of the pain, but doesnt get to the route of the problem

    I Seen a physio last week who has says i have cartlidge problems in my knees so maybe i will have a diagnosis soon, i see her again on Wednesday she is the only one who has helped to be honest, I do hope you get an answer soon as it is very frustrating and .can get you down , i had to stop work due to the pain but hope to get back soon,

    I think I have an arthritic problem and your symptoms seem similar I hope someone listens to you let them know how much It impacts your life, you are not alone best wishes to you ☺ james

    • Posted

      Best wishes to you too, James.  Being told that it's all in your head is more frustrating that dealing with the condition in the first place, in my opinion.  Maybe a physiologist will be the next route I go, if the rheumatologist doesn't work out.  I hope she figures out something to help you.

  • Posted

    Rashes just started a year ago, joint pain ( no real swelling) not major, but... with PA you have tendon and ligament inflammation and pain with this. The pain in my hips, sacral joints and the ligaments in my pelvis seem to be how my symptoms manifest. Couple thoughts, have you had your vit. D tested? Other thought is have you been tested for the various tick born illnesses? I would get a rheumatologist andvtry treatments and not just go by the tests. Crp and sed rate are good indicators but a single data point is not diagnostic. My Rheum professor alway said these diseases are not like diabetes, it's a cage correlation of tests and symptoms...have they done an HlaB25 gene test?

    • Posted

      Tendons and ligaments would explain some of my pains, I think. This spring I had tenosynovitis so bad in my wrist (after gardening for a few hours) that the xray technician thought I had a broken hand bone and had to get a second opinion (and they still couldn't make up their mind).  I've had the standard bloodwork done... blood counts, thyroid levels, and vitamin levels are all normal.  I just pushed to have a test done for Lyme disease, although the doctor was very resistant to it for some reason. I have a feeling she might just ignore the result if it comes back positive.  I'm an outdoor professional and have been bitten by at least a dozen ticks in the last ten years.  However, it's been a few years since my last known tick bite, and at this point it would be stepping into the debatable chronic lyme disease category.  I have had the HLA-B27 gene test, which came back negative.  But I agree that a single datapoint doesn't warrant diagnosis. I pushed for referral to a rheumatologist, so hopefully that will go through.

    • Posted

      Def. the wrist thing... I had Achilles tendinitis 2-3 years ago... hang in there, the methotrexate has helped a lot, in trying acupuncture now and trying to get down off prednisone now... at 10mg and feel crappy going down...just going to drop to 5mg and tough it out!
  • Posted

    Sorry to hear you are having a rough time. I am undiagnosed as yet as

    I am waiting for a rheumatologist but my GP suspects PA despite my joint almost never swelling..so yours could be. Swelling is an indicator of active damage occurring to your joints so it's actually a good thing not to have it. I also have normal inflammatory markers (both on meloxicam/celebrex and off) but my GP has said that it's very common for PA patients to have normal markers, about 50% of us do. As for your rash..it is really difficult to determine the difference between various skin conditions sometimes. Do steroid creams help? Is it raised or well defined? Eczema is usually more itchy than psoriasis but it's hard to compare when you've only experienced one or the other. I don't think it has to be as silvery as what you see on google images, those are often extremely severe cases, but the flaking/scaling is usually slightly shiny. Sorry I'm not much help! .I wish you well. 

    • Posted

      Standard over the counter steroid creams do not help with the rash.  Triamcinolone ointment at 0.5% concentration helps for a few days, but not at 0.1%.  Sometimes (but rarely) the rash just disappears for a while (like now, which is somewhat unfortunate because I can't show my doctor).  The rash is raised and well-defined.  It's mostly circular in shape, but the circular patches conglomerate into big patches on my legs.  It's definitely flaky--scratching it would remove layers of dead skin before I would reach a point where it became oozy (sorry for the graphic picture, I'm just trying to describe it as best I can).  One doctor I saw in the past said it almost looked like a 2nd degree burn.  If/when the itchiness and flakiness subside, I'm left with a pink/red patch that is definitely shiny, and even after the color fades the skin remains shiny for a while.  Good to know that inflammatory markers are often normal for PsA... I'll have to do some more research on that.  Hopefully you see a rheumatologist and get a proper diagnosis soon!

  • Posted

    I have something similar, including the joint aches and pains at times but what you describe sounds like what I get on my scalp, and some facial areas. Have you ever looked into "seborrheic dermatitis"? And "SLE (systematic lupus erythemetos" ) could be the cause of your joint pains / redness. Either one of those things. I'll post a link to a site as well but I have looked into most skin conditioms related to joint pains. Another thing to consider is The immunity responds to various things and in my experience can effect everything from skin to joints to well everything. If it's not functioning up to par I can imagine why it could cause various symptoms like you describe . I could be wrong, I'm not a doctor but I've dealt with doctors for many things only to hit dead ends other then the dermatitis. Hope this helps :

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    • Posted

      I'm really not sure what to think of the skin condition on my scalp.  Sometimes it's just itchy with no rash but seems to be producing extra oil.  Usually it's only itchy when my leg rash is really active, so I'm pretty sure they're linked.

      Doctor just called and said I tested positive for Lyme... but both of us suspect it might be a false positive due to autoimmune issues (yes, she changed her tune yet again).  I haven't been bitten by any ticks recently, and the Lyme test indicates a recent infection, not a past infection.  I'm going to take the antibiotics as a precaution, and we'll see if anything changes.  She is now leaning towards SLE. I'm not convinced it's SLE (the symptoms don't fit as well as PsA or RA), but I'll do some more research on it.  I'm just relieved that she's back on board with me and is maybe starting to think that I am not crazy afterall.

  • cmc2121
    2

    Posted

    Alright folks, I found a few pictures of my skin/nail problems & foot swelling.  Any thoughts based on the pictures as to whether or not this is psoriarsis/PsA?  The leg picture is recent and the rash is only beginning to develop again. Normally it is a darker red color and I have more patches covering about 30-50% of my lower legs.  The hand rash sometimes looks like it does in the photo (look at the base of the ring finger) but sometimes looks like a bunch of tiny blisters, too.  The foot picture pretty much shows the extend of any swelling I get which is mostly just in the toes (except for my wrist tendons).  They're often just bright red and not necessarily swollen but for the past two days they've felt like they've been run over by a truck. The more I use them the more they hurt (same with my hands the past week or so).  You can see I've got some funny nail stuff going on too (white spots on nails, some nails pulling up away from the bed at the tips; fingernails have horizontal ridges and sometimes the nails of fingers affected by the hand rash get pitting).

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