Re: Diagnosing psoriasis?

December 22, 2007

& Grant,

I'm certainly no expert, but I know that it can sometimes be difficult

to determine psoriasis or excema. I do no know that that can

sometimes appear concurrently or individually. It seems quite

possible that Grant may have both, just exhibiting at different times.

I'm not sure if there is any " test " other than a visual examination.

I'd say bring this new diagnosis to his rheumy and see what he says.

Again, quite likely that treatment may not differ much as many cases

of rheumatoid or psoriatic arthritis are treated similarly.

Stay Well,

December 22, 2007

I've been diagnosed at various times with both excema and psoriasis,

and it doesn't really matter what they call it in my case. Treatment

for the skin condition remains the same, and the arthritis is the main

problem for me. Unless the treatment for the skin condition diverges

as a result of the diagnosis it's irrelevant.

RAH

December 23, 2007

Hi. If Grant has toenail involvement, it might present an

opportunity for a more certain diagnosis. I have mild P on my elbows

and knuckles and in my toenails, mild enough that I never brought it

to the attention of my long time dermatologist until I developed

inflammatory arthritis this year. My rheumy didn't seem to care

about diagnosing the P on the theory that treatment of the arthritis

would be the same whether it was PA or RA, but I wanted to know to

help me better understand what is going on inside me. I went to my

dermatologist who took clippings from my toenails and tested them to

rule out other causes. The tests came back negative for other

causes, " indicative of " P.

December 23, 2007

I have both eczema and psoriasis. they appear separately and together. i have

been seeing the same dermatologist for years and he is able to tell the

difference. lou

December 23, 2007

Psoriasis can be confirmed by biopsy. I personally think it's

important to know the correct diagnosis. I was misdiagnosed for

several years as having eczema. The topicals they gave me for it

made the condition worse. I also developed some contact allergies to

some of the products they gave me! This just makes my life that much

more complicated.

Also, most people with PA have a negative rheumatoid factor.

Therefore they will assume you don't have RA. Unless you have a

confirmed diagnosis of P, they might hesitate to treat your arthritis

aggressively because they assume it's " just " osteoarthritis. Things

that work to help OA do nothing to help RA or PA. I also was

subjected to wasted years of being told I had OA when it was PA all

along. Aggressive treatment sooner might have made a big difference

in how severe my PA ended up being, and certainly would have improved

my quality of life.

As someone else mentioned, also look for any sign of nail P, either

fingernail or toenail. My toenail P was misdiagnosed as a fungal

infection. My fingernail P doesn't look like textbook nail P -

instead it mostly shows up as highly inflamed cuticles and peeling

skin under the nailtip, which eventually peels down making it look as

if I bite my nails.

Finally, Grant may indeed have P which is now being mostly controlled

by the meds but something he is using, possibly even those very meds,

could be drying his skin causing secondary eczema.

If Grant has or has had uveitis, as your sig indicates, then it is

almost surely PA, which means he has P for sure.

best regards,

sherry z

December 23, 2007

My nails don't look like the typical nail psoriasis either...pretty

much as you have describes yours SherryZ. The MTX has helped with

that too...at least it hasn't gotten any worse and my Rheumy

prescribes some Clobetasol that helps it. I also don't have any

psoriasis anywhere on my body. My Rheumy says most people have the

P first then get the PA next.

Sharon

December 24, 2007

Hi Sherry,

Luckily for me so far, my P is hidden. It is all over my scalp and

the backs of my ears. My toenails are brittle, almost powder like

when I clip them. Which I assume is some form of P.

But, my fingernails do like yours, which made me feel better that it

wasn't just me. They are not ridged that I can tell, but the cuticles

grow way up the nail, and the skin all around my fingernails peels

back, especially at the base. It is quite gruesome.

What do you do for the peeling? Is this P or just a side effect of

the whole arthritis thing?

Thanks, Tammie

December 25, 2007

Correct - most people have P before PA. I think it's only about 15%

who get the arthritis first. I'm one of those few.

best,

sherry z

>

> My nails don't look like the typical nail psoriasis either...pretty

> much as you have describes yours SherryZ. The MTX has helped with

> that too...at least it hasn't gotten any worse and my Rheumy

> prescribes some Clobetasol that helps it. I also don't have any

> psoriasis anywhere on my body. My Rheumy says most people have the

> P first then get the PA next.

>

> Sharon

>

December 25, 2007

Tammie, the nail thing is from P, not just a side effect. And the

cuticles sticking to the nail - that's definitely indicative of P. Now

that I know more about it, I can see that I had (undiagnosed) nail P

since childhood.

regards,

sherry z

>

> Hi Sherry,

> Luckily for me so far, my P is hidden. It is all over my scalp and

> the backs of my ears. My toenails are brittle, almost powder like

> when I clip them. Which I assume is some form of P.

> But, my fingernails do like yours, which made me feel better that it

> wasn't just me. They are not ridged that I can tell, but the cuticles

> grow way up the nail, and the skin all around my fingernails peels

> back, especially at the base. It is quite gruesome.

> What do you do for the peeling? Is this P or just a side effect of

> the whole arthritis thing?

> Thanks, Tammie

>

December 28, 2007

Sherry- Its interesting what you wrote about uveitis. This derm

was pretty certain that psoriasis couldn't cause uveitis!!! Thats

when my confidence in him was gone. I'm tempted to send him

articles off the internet about it. I've calmed down some since

last week and am waiting to see what the rheumy suggests. I'm

pretty sure that he has no nail involvement at all. We just may

need to get a 3rd opinion and get a spot biopsied to know for sure.

Thanks for the input!

& Grant/10/PsA/Uveitis

December 28, 2007

, by all means send that derm some info about uveitis and

psoriatic arthritis! It could help some other poor soul down the

road. I have sent or given info to several orthopedists and

internists who should have been able to diagnose my PA over the

years, but didn't. I included a letter urging them to examine nails,

to ask questions about skin lesions and eye problems and urethritis,

etc., to ask about relatives with P, etc. whenever they have a

patient presenting with flare/remit joint pain but negative RF factor.

In the meantime find Grant another, more well-informed, derm. Also,

is Grant under the care of an opthalmologist for his uveitis? Does

the optho understand the relation to PA? If not, give him some

links, too. And cue him to ask about possible PA when he sees anyone

with uveitis or iritis.

best wishes to you both,

sherry z

January 3, 2008

Hi Sherry! Today I sent off some info to that derm. I hope he

learns something from that. Grant see's a ped Opth for his

uveitis. He is very good. He is the one who referred us to the ped

rheumy to get us the dx of PsA. Do you have Uveitis?

& Grant 10/PsA/Uveitis

January 3, 2008

Hi, . Grant is very blessed to have you as his advocate! I'm

glad you sent the derm that info - anything all of us can do to help

educate the public, and especially physicians, about PA will help us

all. I'm also very glad to hear that Grant has such a great

opthalmologist.

Thankfully, I don't have any eye involvement. Not yet, at least. One

thing I've learned about PA is that anything can happen at any time

with no warning and no apparent reason. Not knowing what the future

holds, I'm just thankful that today is not too bad. :-) So far, I've

been spared uveitis, iritis, costochondritis, and large-scale P on my

trunk.

best regards,

sherry z

>

> Hi Sherry! Today I sent off some info to that derm. I hope he

> learns something from that. Grant see's a ped Opth for his

> uveitis. He is very good. He is the one who referred us to the ped

> rheumy to get us the dx of PsA. Do you have Uveitis?

>

> & Grant 10/PsA/Uveitis

>

January 5, 2008

Hi

I read your letter and thought i would throw in an experience of my own. I have

had PA for about ten years . Anyway I was sitting at home about three weeks ago

watching tv when I suddenly went blind in one eye.I was told that there is

nothing they can do and that it probably has a cause in my PA. I had never heard

this before and I must admit it took me by surprise.

Walt

January 6, 2008

Walt, was this a temporary blindness? Are you OK now?

I have ocular migraine, which causes my vision to go blurry and tunnel-

like in one eye from time to time. It only last a few minutes - from 3-

15 or so. Mine are triggered by glare or flashing lights usually. The

first time it happened it scared me to death. Ocular migraines are

caused by changes in blood flow to the area of the brain responsible

for vision, possibly due to vascular spasms. Ocular migraines are

considered harmless and usually don't require treatment if they don't

go along with a headache - mine don't.

Of course, PA can also cause some more serious eye problems. Any

vision disturbance or eye pain should be checked immediately.

best regards,

sherry z