Kickas.org Forums Ankylosing Spondylitis General Discussion #1 AS Web Support Group More than one thing going on .... ?

I have been on the NSD for about 3 months now. Initially the benefit was like night and day for my achey stiff back and neck,
and part of this was probably due to the fact that I was also still taking celebrex ( albeit at a lower dose prior to NSD ).

1 month into the NSD when I started majorly throttling back on the celebrex, I started to get swelling in one joint in my
left hand, and tenederness in another. Also about this time I got a 2nd opnion from a Rheumy and she said because of the
sausage fingers and skin rashes behind my ears, hairline, navel, that it I probably had psoriatic arthritis and not AS.

When the swelling in my fingers got really bad I would start taking celebrex again and for the most part the celebrex would reduce
the swelling or hold it in check. During one of my trials of coming off the celebrex ( as my long term aim is to be drug free )
I found that taking magnesium and joint supplements seemed to hold my hand joint pain down and swelling to a reasoanble level.
Unfortunately what started off with 2 joints in my left hand , has now spread to 5 joints ( 3 ICP joints and 2 MCP joints ).
And I feel it is now "jumping" to my right hand as one of the knuckles there is starting to get tender.

From all I have read on Psoriatic arthritis, the hand inflamation is usually asymmetric, wheras rheumatoid arthritis is symmetrical.
If more joints in my right hand get inflamed, then my symptoms will start to take on more of a symmetrical nature.
I have an appoitment to see a Rheumy about my hands, unfortunately it is in a month and so thought I'd ask around here to see if anyone
has a symptom progression similar to mine, and if so whether they had any insights into what maybe going on.

So to summarise,

I started off with a "possible AS" diagnosis from Rheumy A, but after a bone scan was told it wasn't AS ( funny thing is brother has AS )
During time I was waiting for results to come back, tried NSD and got major relief from it.

When I went to see 2nd Rheumy, back / neck stiffness pain etc were minor, and because of my sausage fingers and skind rashes, was given
a diagnosis of Psoriatic arthritis.

Number of swollen joints in left hand has slowly increased, now right hand is starting to show early signs of joint inflamation. PsA
usually is asymmetric, my symptoms seem to be progressing towards being symmetric.

4 months ago last time I had blood tests, I was negative for RA, and also had low ESR of 7. 6 months previous to that when I had
blood tests, I was also negative for RA, and low ESR of 7 despite being in a lot of pain from my back and neck.

Anyone see any similarities to what they have had ?

Does swelling spreading to other hand, possibly indicate a rheumatoid condition, rather than a spondy family disease ?

TIA

Hi, TIA:

There are few "typical" things about AS, but men follow a pattern more than women, usually. The main thing is that, if your brother has the B27 antigen and has AS, you probably have AS and you did not mention B27 status, but before your physician decides that you have PsA it would be good to find out.

We seldom have much hand swelling, opposed to RA where it is universal and symmetrical (just as you have found out). RA and AS have gender and age gaps, with onset of RA usually about 20 years later often following UTI and more common in women than men with most possessing the DR4/DR1 antigens. We more often get sausage toes than fingers.

The fact that the NSD helped is not very informative since you have avoided gluten (some PsA has been caused by celiac/sprue) and there are other inflammatory conditions that respond to starch restrictive regimens, from reports we have received (including RA, btw).

It is certainly possible to have RA or PsA in addition to AS, but it is more likely that the swelling is due to AS, as another uncommon manifestation of this disease. I wish that I had some suggestions from experiences for you, beyond the usual EFA and other supplementation that you are already aware of from the NSD Forum.

Good luck to You,
John

Hi TIA - Couldn't sleep so... Did a bit of digging around, thought the following might help - first website seems the best, most informed/information. Mentions AS. Good reading:-

http://ard.bmj.com/cgi/content/full/58/3/142 - Polyarthritis and pitting oedema. Good site.

http://www.assh.org/Content/NavigationMe...s_Rheumatoi.htm

Arthritis, RA.

http://uwmsk.org/residentprojects/psoriaticarthritis.html - Psoriatic Arthritis: good overview

http://patients.uptodate.com/topic.asp?file=arth_rhe/6976&title=Psoriatic+arthritis -

Patient information: Psoriatic arthritis

Molly
Keeping on Keeping on (digging by moonlight - at 4.30am!!)

DragonSlayer,
I had the B27 test, and it came back negative. But I have read on this forum, that it can sometimes be incorrect. My brother doesn't recall having the test either, but said there was some test they did, after which he was diagnosed with AS. Our father does have Ulceritive Colitis, so I think there is definitely some genetic link.
Regarding Age, I am approaching 40, so close to the upper limit for first diagnosing AS ???? My brother was diagnosed in his early 30's , but started suffering in his late 20's.

Regarding the NSD, I can't as yet say it gives me total consistent relief. I have periods when my back and neck pain comes back, some of the time they coincide with my deliberate testing the limits, by having a no no food. Other times I have no idea why I wake up that morning and I am stiff, in pain etc. But throughout this time, the swelling in my fingers has been steady and gradual. I believe the diet helps with my back and neck pain, but has no impact on the swelling in my left hand.

Molly,

Thanks for the links. They were very informative. With their help I will have some informed questions I can put to the Rheumy when I see her.

Reading the descriptions of PsA, I still don't think my symptoms match up 100% with what I see in there. For example they say you often get nail pitting, or problems with PsA. I have none. It also makes no mention of how the disease sometimes progresses. For example in my case, the PIP ?? ( finger joint ) usually starts of with a tender hot spot on the left side of the joint which eventually spreads to cover the whole joint. When it starts in my MIP joints ( knuckles ) the whole thing starts of red, not just one small area. And that's what I am starting to see in my right hand's knuckle. The onset of which , is 3 months after the first swelling noticed in my left hand.