Really more of a social anxiety issue

April 19, 2021 10:46 AM

I think I might have psoriatic arthritis, but if not, I have three separate symptoms I’d like to get medical attention for. How do I approach this?

Very dumdum question, sorry, I grew up without health insurance and am very awkward about going to the doctor.

Most of my life I’ve had some scaly skin— very mild— on my scalp near my temples and near my navel. T-Gel shampoo has mostly fixed the scalp, and the navel irritation comes and goes. I never thought much of it.

In the last few years, I’ve been getting quite bad joint pain and have tried many things to treat it— muscle strengthening exercise, SAMe, ibuprofen, weed, dietary changes. It stays pretty much the same and recently has felt worse. (I just got my first shot of Pfizer last week, not sure if that could have an effect.) I’m around 30 so the possibility of irreversible joint damage is starting to freak me out. I wanted to go in last year but COVID struck right around my appointment.

I also have mild nail separation. Some of my fingernails are detaching a bit in weird patterns. I’ve noticed getting a bit worse recently.

Anyway, my partner’s dad has psoriatic arthritis and I just realized all these symptoms might go together. If I want to be screened for that but also get treated for the individual issues, how do I approach this? Tell me doctor I’m concerned because someone I know has the diagnosis? Just bring up all three things? All the symptoms except the joint pain are pretty mild, should I focus on the pain and bring up the other stuff as a side note? Should I see a dermatologist or go to a GP?

Thanks!

posted by stoneandstar to Health & Fitness (9 answers total)

If you can swing it without a referral, try a rheumatologist. They'd know most about arthritis (and these do seem like classic symptoms).
posted by kingdead at 10:54 AM on April 19, 2021

I have psoriatic arthritis and while I eventually found an arthritis-specialist rheumatologist who diagnosed me properly, the GP and previous rheum just sort of shrugged and called it seronegative rheumatoid arthritis, which it wasn't, and - critically - doesn't respond to the same meds. You might get more mileage out of going to a dermatologist first, get the psoriasis diagnosed, and take that diagnosis to a rheumatologists. (Your situation is a little different because you connected the skin problem and the joint problem on your own, while mine didn't click for me - my new rheum asked if I had any skin issues and I sort of diffidently explained my weird flaky ears and that was what did it.)

Just whichever order you do it in, mention the joint pain *and* the skin issues. It'll simplify everything.
posted by restless_nomad at 11:01 AM on April 19, 2021 [4 favorites]

A rheumatologist will be able to interpret your symptoms (joint pain and skin inflammation) and order a panel of blood tests that look at levels of specific factors associated with an overactive immune system. They will be able to prescribe medications that will target and help reduce that inflammation, such as prednisone, methotrexate, etc., given a positive diagnosis.
posted by They sucked his brains out! at 11:45 AM on April 19, 2021

I was just diagnosed with PsA. I was diagnosed with Psoriasis by a dermatologist several years ago. In my case it was mild, but the dermatologist warned me at the time that I was susceptible to Psoriatic Arthritis down the road. Fast forward a few years when the joints in my hand became so painful that I couldn't wash the dishes or put on a bra I remembered his warning. My dermatologist had since relocated so during my first major PsA flare I turned to a specialist who has dual degrees in Dermatology and Rheumatology and who diagnosed me promptly based on my symptoms. This was after I was initially misdiagnosed with gout by another provider. Trust yourself - you know your body best.

I agree that the psoriasis diagnosis from a dermatologist is helpful to start and can help inform the rheumatologist. It helped me. But a rheumatologist is who you will need to see to manage the condition and medication regime. All of that affects how the insurance company will review your case and approve you for biologics if you want to go that route.

I would recommend before you visit either specialist that you make a succinct list of all of your symptoms and any timeline. No matter whether or not you think it might be related - throw it in there. I had skin irritation that had been misdiagnosed by a GP and the rheum needed to see it. It helps to have it written down so that you don't forget anything. All of that is useful for the specialist and helpful for them to negotiate with the insurance co's.

I had a slight flare after my first Pfizer injection - and painful lymph node inflammation (like interrupting my sleep pain) so I think that the vaccination can absolutely be affecting you.

I'm in New York - feel free to memail me with any questions or a Dr. recommendation if you're nearby.
posted by rdnnyc at 12:54 PM on April 19, 2021 [1 favorite]

The person in my family saw his GP first for bloodwork, and when she saw his inflammation markers in the results he got referred to a rheumatologist asap. (This was all Blue Cross/Blue Shield PPO, they probably did require the referral. You may have better options.) He was already presenting with serious joint pain for his age, but we got the impression that even if it had just been plaque he would have gotten the same referral based on the bloodwork.

Don't dawdle anymore; get to whoever is fastest to get to right now to get that bloodwork ordered and a referral in motion. Where we live that would not be a rheumatologist, the GP or dermatologist route is probably faster in most cases as they're much more geared toward faster-moving appointment-booking.

You want something like a diagnosis before you begin treatment. You will be able to access some treatment for symptoms that you can try, but in our experience the only thing that controls either family of symptoms is ongoing treatment with biologics, and on a couple of occasions removing some fluid around a particularly badly-flaring joint, maybe eventually physical and/or occupational therapy. There's just no shampoo or cream or pain reliever that does anything.
posted by Lyn Never at 1:19 PM on April 19, 2021

re: joint pain - if you live in an area with ticks, this could be lymes disease. Don't freak out (it could be other things!) but a friend of mine had mild to moderate joinT pain for years, got a number of incorrect diagnoses, and it finally turned out to be untreated lymes. Anyhow, it cannot hurt to ask to get this ruled out when you see a doctor if you are in a region with ticks.
posted by coffeecat at 3:10 PM on April 19, 2021

I would go to a general practitioner first and let them decide how to go forward. Suspecting you have X and going from there could be really counter productive.
posted by Billiken at 12:29 PM on April 20, 2021

Response by poster: Thanks Billiken— I’m concerned about that too, but that’s why I’m asking the question. If I come in with two mild physical symptoms and one major invisible symptom and pretend I have no suspicion that they’re related... seems much more bizarre than just saying what’s on my mind. I don’t mind being told that I’m wrong (would be glad to be!).
posted by stoneandstar at 12:49 PM on April 20, 2021

In my experience, most reasonable doctors respond well to some variation of "These are the multiple symptoms that I'm experiencing. I'm concerned that they might be connected, from partner's dad's experience, but of course I'm not the medical expert in the room here." Where they get annoyed is if a patient insists that they know more than the doctor. You, of course, know the most about your own experiences, and a reasonable doctor shouldn't tell you that you're not feeling what you're feeling. But I've had generally positive outcomes with keeping in mind the 'I'm the expert on how my symptoms are presenting, they're the expert on interpreting and diagnosing causes' framework. From your description, if you do bring up your concern about psoriatic arthritis, it sounds like you would almost certainly do so in a way that won't raise the hackles of any reasonable doctor, and the context that it seems very similar to the experience of the specific other person who you know well enough for that to be relevant (not just some story you read on googling your symptoms) seems like it would be helpful diagnostic information.
posted by eviemath at 9:13 AM on April 21, 2021