RA, PsA and AS at the same time?

Question

I was diagnosed 3+ years ago with Psoriatic Arthritis, Ankylosing Spondylitis, Osteoarthritis, and Fibromyalgia. I exhibit a number of stereotypical signs of PA, such as severe pain and inflammation in my hand and foot joints; particularly in the end joints of my fingers and toes. I frequently experience Achilles tendonitis in both feet/heels, as well as tendonitis in both my wrists. I also have tightness in my chest accompanied with tenderness in the joints around my breastbone. In addition, I have severe pain and inflammation in my lower back that causes pain and limited range of motion in my right hip, as well as a feeling of having pinched nerves and numbness in my groin area. Similar pain, stiffness, and inflammation in my neck that affects my right shoulder and arm also occurs. However, I lack one key symptom of PA; psoriasis. To date, I have not had any skin changes or symptoms.

Though my blood work continues to be negative for RA, I still question whether some of my symptoms do, in fact, point to RA rather than PA, such as the absence of skin symptoms and the occurrence of nodules on various joints.

I currently take Methotrexate and Enbral to treat my PA and AS. While this has helped to a slight degree, nothing I have tried to date has helped to manage the symptoms completely. Even one day without pain would be a blessing.

First, is it possible to have RA even when blood work indicates no? Second, are the medications used to treat PA the same as those used to treat RA? Third, is it possible to have both PA and RA? Lastly, are there any new treatment options to reverse the damage and stop the pain?

Answer

It would be highly unlikely to have all 3. There is always one entity which explains most of your symptoms. Psoriatic arthritis can have a rheumatoid arthritis like presentation in 15% of the cases. Ankylosing spondylitis can also be accompanied by arthritis of the small joints. While psoriasis does have great weight when making a diagnosis of psoriatic arthritis it is not an absolutely necessary criterion.

Drugs from the class of anti-TNF inhibitors are FDA approved and work well for all these 3 diseases.

Ana-Maria Orbai, MD MHS

About Ana-Maria Orbai, MD MHS

Instructor in Medicine
Johns Hopkins Arthritis Center