Patient's Query
Hello, Doctor,
I’m 46 and have psoriatic arthritis, and lately my knees and fingers have become much stiffer, even though my skin psoriasis actually looks better than before. I keep asking, can psoriatic arthritis get worse even when the skin symptoms improve? I always thought both problems would flare together, but now I’m not so sure. I haven't missed any injections or medicines, so I’m perplexed about why my joints keep hurting more. I don't know if this situation means the treatment isn't working anymore or if this kind of thing just happens sometimes. Even opening jars has become much more difficult than it used to be.
Kindly advise.
Thank you.
Hello,
Welcome to icliniq.com.
I read your query and can understand your concern.
Skin and joint symptoms in psoriatic arthritis are not always correlated. Your joints can flare up even when your skin is clear, and your skin disease can get worse without any increase in joint symptoms. Psoriatic arthritis has different domains of disease, so your treatment needs to be targeted to the areas involved.
Psoriatic arthritis is a progressive inflammatory disorder. If not treated, it can cause permanent joint damage, erosions, deformities, and loss of function. The sooner you get diagnosed and treated, the better for your joints and your mobility.
If you are on Methotrexate and your disease is still active, your rheumatologist may increase the dose up to 25 mg (milligrams) once a week, which is the usual maximum dose. If symptoms do not improve, then consideration should be given to biological therapy.
Here are some biologic medications that work for psoriatic arthritis:
Inhibitors of tumor necrosis factor (TNF).
Inhibitors of interleukin-17 (IL-17).
Interleukin-12/23 (IL-12/23) inhibitors.
The type of biologic depends on your symptoms, disease severity, and other medical conditions.
You should see your rheumatologist around three months after starting biologic therapy to see how you are doing. Depending on your improvement, your current treatment will either be continued or changed to a different biologic if needed.
Pre-biologic therapy studies
Complete blood count (CBC).
Erythrocyte sedimentation rate (ESR) test
C-reactive protein (CRP)
Alanine aminotransferase (ALT).
Aspartate aminotransferase (AST) .
Serum creatinine.
Hepatitis C antibody (anti-HCV)
Hepatitis B surface antigen (HBsAg).
HIV Ab (Human Immunodeficiency Virus Antibody)
Tuberculin skin test or other tuberculosis screening tests.
Chest x-ray
X-ray of the hand for joint damage.
Therefore, get these blood tests done too.
I hope this information helps you.
Take care.
Same symptoms don't mean you have the same problem. Consult a doctor now!
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