When I initially saw my rheumatologist, she told me that my bloodwork did not clearly indicate RA vs. psoriatic arthritis; she was leaning towards RA at the time but not certain.  At today's visit, I saw that my chart now says PsA, and asked why it had been changed from 'non-specific inflammatory arthritis' to PsA.  Her answer was that she felt this was more accurate given the specific joints that are affected on my body.  I have no skin involvement at all.  I saw my dermatologist recently and had a full body check, so I'm comfortable that I'm not missing anything there.

My doctor told me that the treatment depends on symptoms and the efficacy of the drugs we've tried, and the diagnosis really only matters because it may help with the insurance company if it is more specific; her experience has been that they sometimes raise questions about prescriptions if she calls it 'non-specific'.  Since it is not affecting my skin and there's no need for topical treatments, it sounds like the protocol is the same as it would be if I officially had RA.

I'm interested in thoughts from anyone who has psoriatric arthritis with no skin symptoms.  Is there any difference when you get right down to it?  I don't mean from a clinical point of view - I mean on a day to day basis.  We're still talking chronic condition with flares, still talking about movable-target symptoms, still talking about potential organ involvement, right?  Also, my understanding is that a certain percentage of people who present with psoriasis eventuially develop PsA.  Is the reverse true?  Am I likely to see skin patches developing at some point?  ('Cause, shit, I really don't need another thing, you know?)  In other words, I've gotten my head around the idea that I had RA.  Do I need to adjust headspace to reflect it being PsA instead?

We're increasing the mtx dosage and switching to injections.  Since I have only had two injections of Humira due to her office staff screwing up and delaying the prescription by nearly three months (for which I received a heartfelt apology, and I learned that the staff member in question has been dismissed since something similar happened to at least two more patients as well) it's too soon to tell if it's effective or not.  I'm continuing Celebrex for inflammation and Tramadol for pain, folic acid to buffer side effects from the mtx, and vitamin D because bloodwork showed a deficiency. So the only change today is the increase in the mtx and doing it as an injection.

I'll go back in two months instead of three, and if the Humira / mtx combination isn't working by that point, we will switch to something else.

I'm happy with today's appointment for several reasons.  She took me seriously when I began the appointment by saying calmly that I have had increased symptoms and I wanted to leave her office with a plan in place for changing the course.  I am not always good at speaking up; I'm much more likely to downplay symptoms, but this RA or PsA or whatever has taught me otherwise, and i did a good job of speaking up today.  My hips hurt, my shoulders hurt, my hands hurt, and I'm so tired all the time.  I told her that I had a fairly long list of symptoms that may or may not be related to arthritis, and she listened to the whole list and discussed each one.  I'm sorry that the woman who was so difficult to deal with on her staff has lost her job, that's not a casual thing, but since it sounds like she caused problems for others besides me, I'm not losing sleep over it.

So that's where I am, friends.   I'm not on the upswing yet, but I do feel that our communication is good, and that there is a plan, and that goes a long way right now.  And on a totally unrelated note, I have a four day old lamb following me everywhere on the farm since I'm bottlefeeding her and she thinks I'm her mama, and it's kind of awesome.  I mean, right now she's asleep on the back porch ont he boot pile, waiting for me to come back out.  And the sun is shining.  Just thought I'd mention that.  Life is more than arthritis.