Hi Stacy,
Sorry things aren't going so well... you mention that you are seeing a dermatologist... do you also have a rheumotologist? Correct me if I'm wrong, but it sort of sounds like the doctors are treating your symtoms instead of trying to stop or slow down the disease. Have they tried you on any of the disease modifying drugs (DMARDs). I have not tried Enbrel for the same reason... my insurance doesn't cover injectables beyond insulin... and with regards to insurance... RA and PA appearing on a private health or personal life insurance application will get you declined almost immediately. (JOY)

You shouldn't have to live with 365 days of constant pain when there are approaches to this disease that can at least slow it down or suppress the symptoms. Has your doctor ever tried putting you on prednisone short term to try and break your cycle of inflammation? ... and again, has anyone prescibed any DMARDs? I've been on Methotrexate and Arava in combination and have no more problems with the psoriasis part and have mostly pain free days (short of over doing it no and then) The biggest hurdle to living and dealing with this disease is stopping the damage it does long term. Treating symptoms alone does not protect your joints pver the long haul.

Rereading your entry, I feel so badly that you are dealing with so much daily pain. During my first 2-3 years with PA I only used NSAIDs...I didn't want any part of the long list of possible side affects from the DMARDs. I was exhausted and in pain most of the time, and very bummed that life was passing me by. When I finally swtiched rhuemies, I told him I was willing to try anything that would allow me to have fun with my three boys and husband again. There are a lot of drugs out there that can be used or tried. He layed them out as good, better, best..... which also seemed to follow inversely as to the amountof possible side affects. However, for me it became quality of life. With careful monitoring (blood tests and doctor visits) you can minimize any complications that may arise from those drugs. I'm 43 now, and when I think back to how I felt, walked... I felt like I was 83. Can this disease go away or go into remission. I guess it can, however, I haven't heard of it happening to anyone that I know. My biggest regret in the 7-8 years that I have been dealing with this disease is that I wish I would have foresight to be more aggressive with my treatment from the very beginning.

Try to be realistic and optimistic... stress can really do a number on your body. You can't turn back the clock or make this go away. But you do have the hope for a better tomorrow. I always look out at the world and I'm thankful it's only PA that I'm dealing with (in light of all the other diseases that are out here.) Reach out and try to comfort or help others,... it often seems to lighten the load your feeling on your own shoulders.

I do believe that there are treatments out there that can reduce and control all the symptoms you are going through. ... and yes, 7 years later I do feel better now than I did during those first years... and I believe you can feel a lot better too! Hang in there and keep us posted! Renee

I found this info about Psoriatic Arthritis... various forms of tendonitis are indeed part of the disease process.


Psoriatic Arthritis FACTS
Psoriatic arthritis is a specific type of arthritis. It causes inflammation in and around the joints, usually the wrists, knees, ankles, lower back and neck.

Psoriatic arthritis is a specific type of arthritis that has been diagnosed in approximately 23 percent of people who have psoriasis, according to the Psoriasis Foundation’s 2001 Benchmark Survey.

It commonly affects the ends of the fingers and toes. It can also affect the spine. The disease can be difficult to diagnose, particularly in its milder forms and earlier stages. Early diagnosis, however, is important for preventing long-term damage to joints and tissue.

Most people with psoriatic arthritis also have psoriasis. Rarely, a person can have psoriatic arthritis without having psoriasis.

What are the symptoms?
*Stiffness, pain, swelling and tenderness of the joints and surrounding soft tissue.(tendons)
*Reduced range of motion
*Morning stiffness and tiredness
*Nail changes, including pitting (small indentations in the nail) or lifting of the nail—found in 80 percent of people with psoriatic arthritis
*Redness and pain of the eye, similar to conjunctivitis

How does it develop?
Psoriatic arthritis can develop at any time. On average, it appears about 10 years after the first signs of psoriasis. For most people it appears between the ages of 30 and 50. It affects men and women equally. In about one of seven people with psoriatic arthritis, arthritis symptoms occur before any skin lesions.

Like rheumatoid arthritis, psoriatic arthritis is thought to be caused by a malfunctioning immune system. Psoriatic arthritis is usually milder than rheumatoid arthritis, but some patients with psoriatic arthritis have as severe a disease as patients with rheumatoid arthritis.

Psoriatic arthritis can start slowly with mild symptoms, or it can develop quickly. It is very important to have as early and accurate a diagnosis as possible. Left untreated, psoriatic arthritis can be a progressively disabling disease. In fact, half of those with psoriatic arthritis already have bone loss by the time the disease is diagnosed.

How is it diagnosed?
There is no definitive test for psoriatic arthritis, but the following steps are usually involved:

*Person with psoriatic arthritis talks to physician
*Physician may refer person to rheumatologist, who specializes in arthritis
*Diagnosis is done by process of elimination using medical history, physical examination, blood tests to rule out other diseases and X-rays of the affected joints.


With regards to how much Methotrexate is safe or needed...That question is best answered by your doctor. I have taken both the tablet and the injectable form in varying doses for Mtx. I find the injectable has been more effective for me...however, mtx alone didn't control my PA ...I needed Mtx and Arava. My doctor tries to keep me on the lowest doses possible which means sometimes fluxuating the dose up when I need more control and lowering it when my white count gets a little too low. The other issue with both drugs has to do with how well your liver handles them. Even with Enbrel, my doctor said he would keep me on Mtx if I switch from Arava to Enbrel or even Remicade.