osteoarthritis or PsA, is there a difference?

** Originally posted by lambren **

Last year I was diagnosed with end stage osteoarthritis of my right hip, thought to be cause by hip deformity as a child I had Leggs-Perthes Disease which can damage the hip joint during its active stage. Hip replacement is not an option at this time due to other concerns (age & weight).

I have had problems with psoriasis all my life but this past year has been the worst. Recently I was told I have PsA in my other joints. Could the hip problem be PsA?

The last few days have been in agony. The only thing I have for pain is oxycodone which is of no help. I wake up stiff and in pain and walking makes the pain worse. Walking is also very painful due to the psoriasis is on the bottom of my feet.

I am waiting for my insurance to approve Humira, but they are draging their feet. Will the Humira help all joint pain?

Thanks for any replies. This board has been so helpful to me in the short time I have been reading. Everyone has been so nice and just knowing I am not alone with the struggles of P (although it would be nice if there were a cure so none of had to go through this) has helped me so much.

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** Originally posted by realtor910 **

Hi lambren! To answer your question yes there is a big difference between Osteo Arthritis and PsA. Osteo is caused by wear and tear on the joint usually attrituted to age, sports and other activities. It is actual bone rubbing on bone as the cushioning cartelidge has worn away. PsA on the other hand is an auto immune disease which affects the joints, tendons and facsia (connective tissue) by means of inflammation. As my Rheumy tells me all the time (as I have Osteo in my hands) there isn't much to do for it, heat/cold therapy, pain releiving creams, pain meds whatever works for me to releive the pain but thats all that can be done releive the pain. In PsA the point of therapy is to address the underlying cause of the inflammation which is an immune system run amok so to speak. Hope this explanation helps you out. I am sorry to here that you are in so much pain with the hip and PPP on your feet and I hope you get on the humira soon! Deanna

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** Originally posted by Kentucky_Girl **

welcome lambren. deanna has explained osteo and PsA very well. does that mean that since you have osteo in your hip that PsA will not ever affect that hip? i don't think PsA knows that it is supposed to leave certain areas alone. i think it is possible to have both osteo and PsA in the same joints. if the medications for PsA bring some relief for your hip also, then you'll know for sure.

this is a great place for support and learning. sorry that you need to have found us here but again, welcome. stick around and ask questions and join in. you'll meet great people.

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** Originally posted by lambren **

Thank you Deanna for your info it is greatly appricated and has helped understand the differences between the 2 types of arthritis.

Kentucky_girl thank you also, I was wondering if both could be in the same joint.

Every one has been so nice to me and I have learned so much already and know I have so much more to learn.

I also want to thank Richard for his warm welcome which I did not address in a previous thread for which I appoligze.

Brenda

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** Originally posted by Flycaster **

Lambren, welcome. Deanna has answered your first question very well, but I think you also want to know if Humira will prevent additional damage and help alleviate the pain, yes? If so, the simple answer is you won't know until you trial it. What we've found on this board is that some people respond to Humira, others to Enbrel, some to Simponi, some to MTX, etc., etc. However, these drugs won't do much, if anything, for existing OA damage. I have OA as well, and I know how much it hurts. Have you tried steroid injections for the OA? They sometimes can work wonders.

What I CAN tell you is it sounds like you have a good relationship with a rheumy who not only takes your condition seriously, but is ready to throw some heavy meds at it. That is very encouraging. Do let us know how it works out with your insurance, and how the meds ultimately works. Personally, I know only too well that narcotics don't get rid of the pain. They dial down the "give a rip" meter a bit, but the pain is still there. The key is to get on the right med, and (truthfully) you won't know until you're on it. So hang in there. Fighting arthritis of any type is a process.

Take care, and report beck.

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** Originally posted by lambren **

Thank you flycaster. I have had 3 steroid shots to the hip and am now told that is it. The last injection was very painful during the actual injection but did work for about 4 months.

I will update if and when Humira is approved. These boards have been very encourging and right now I need all the encourgement I can get.

Thanks to all.

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** Originally posted by Flycaster **

If you're done with the localized steroid shots, you're done; I'm sorry to hear that. Can you get enough daily exercise to start slowly chipping away at the extra weight, or does the pain have you totally immobilized? When it comes to bad hips and knees, every single pound helps, but if you can't do it, or if you have an endocrine disease, you're between a rock a and hard place. It can still be done, but it makes it so much tougher.

Either way, I wish you the best.

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** Originally posted by Ranger05 **

FC, i'm curious is to why someone would have to be done w/ the needle? Over the past two decades I have had maybe 15 shots in my right knee (most pre-psa). And another dozen or so shots in my elbow. I was told there was really no limit to the number of shots one could get in a lifetime. It was just a matter of effectiveness and possible tissue damage.

I know Cincinnati Sports Medicine will only give so many shots in a period of time say maybe (2 shots in a 18 months), but as far as I know they don't cap the total number of shots.

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** Originally posted by Flycaster **

...It was just a matter of effectiveness and possible tissue damage...

Ranger, from what I've been told, that's the bottom line. My hunch is her hip is so damaged that they may be afraid of steroid induced necrosis, or some other sinister steroid related side-effect. If it were me, however, I'd continue to push for addtional shots since it seems that she now has no alternatives. Regardless, it's the rock vs. the hard place.

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** Originally posted by lambren **

Hi

Receiving a steroid in the hip joint is more difficult than most other joints. To get a steroid in the hip requires a CT scan to guide the needle to the joint. From what I have been told is that there is only a small opening in which the needle can be inserted as there are nerves that can be hit and can cause severe damage. I have also been told that every shot causes scar tissue which makes the opening for next shot smaller. That is why the last shot I received was more painful as it was difficult to get the needle in the right spot.

As far as getting exercise to lose weight is very hard. I am in extreme pain after only a few minutes of walking and the p on the bottom of my feet is very painful just sitting with my feet not elevated even more painful when acually standing.

So yes I am between a rock and a hard place. I have lost some weight but am at a plateu (sp?).

I have had to quit work because of the p, since I could not tolerate my feet in down position and my job was 8 hours of typing it was getting hard with the p on my fingertips and nails (palms too).

My life is messed up with pain. All I can do is pray for something to change. My outings consists of Dr. appointments, so much fun.

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** Originally posted by heidi **

Welcome to the boards.

I was shocked to find out this year that in adults they do not do anesthesia for joint injections especially the hip and jaw. In children they do it under anesthesia because of how painful it is.

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** Originally posted by lambren **

I received local for injection but when radiologist hit wrong spot I certainly felt the pain. I think the reason adults are kept awake is we understand the need to remain still. The dr needs to know about any discomfort experienced. I know the dr hit my nerve and I was able to express the pain.

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** Originally posted by Flycaster **

They've never used anesthesia for any of my shots either, just numbing shots of lidocaine. "Numbing", my butt...frankly all they do is dial the pain down from a 10 to a 9+. I have to say they are still worth it: 3 months of almost no pain vs. 1 minute of agony. That said, I've never understood why they don't just stick you with a slug of demerol. You'd be awake, and you wouldn't care no matter where he sticks the needle.

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** Originally posted by Ranger05 **

I must have a high pain tolerence which is always a good thing with this disease huh!? I don't mind cortisone shots much. I don't recall the hurting any more then any other shot.

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** Originally posted by Flycaster **

It all depends on the joint narrowness, inflammation, and the shooter. I've had shots from a few real pros, and even more from docs that fumble around, hitting everything BUT the opening. Using a scope (they all do now) I have no idea how docs can miss, but man oh man, they do.

I tell ya, Ranger, if you'd ever had them hit a nerve bundle in your lower back, even you would be singing. Lol

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** Originally posted by eskimo **

Just out of curiousity, how old are you?

Anyhow, Legg-Calve-Perthes is a disease in which the head of the femur (thigh bone) dies due to lack of proper blood supply. Over time, the head of the femur becomes deformed and this will ultimately result in degenerative changes in the hip joint. If severe enough it will proceed to end-stage OA eventually. sometimes if caught early, preventative techniques or early surgery may prevent later joint degeneration but once it has progressed to end stage not much can usually be done outside of hip replacement.

It is possible that successful treatment of PsA may delay the need for hip replacement by a few years in your case, but my guess would be that replacement is probably inevitable.

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** Originally posted by lambren **

I am 49 years old and have been told I am too young for replacement surgery.

I was 5 when I had Perthes disease and back in 1966 the only treatment available was wearing a brace to limit weight bearing in hopes of limiting deformity. (I was wearing platform shoe before the 70s, lol) I was never offered surgery to correct the deformity before reaching end-stage OA.

eskimo, you know a lot about perthes, do you have someone who has had it? Most people do not have a clue what it is.

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** Originally posted by lambren **

I spoke with my Dr. on Fri. and he still will not order another cortisone shot to my hip and he knew I was in pain. When I was in his office it was one of my really bad days. All he could offer me was a different prescription for pain management. Not too different, switched from oxycodone with tylenol to oxycodone with ibrophine. It was at my suggestion for the change, as I felt the ibrophine would be better for the inflamation. The Dr. did not give me much hope just said my life consisted of rest & pain meds.

I have only been on the new pain med for 1 day, too soon to see if it works better. Hopefully the inflamation will lesson & I will not have to be in as much pain as before. Less pain = movement = exercise = weight loss = hip replacement. As long as the PsA does not pull me down. PsA is in my knees, ankles, back and hands which I think is mild-moderate depending on which day you ask me.

Thanks for reading my ramblings!

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