Psoriatic arthritis in fingers

Hello,

I have been reading posts here on and off for at least a week now. This is the first post I have put up. I will keep it shorter so that it doesn't go on forever. About 1-2 years ago or so I noticed something with my elbows and showed my dad. He has psoriasis as well as "Psoriatic Arthritis". He looked at it and said "yea you have psoriasis". Since then it has come on and off. Right now there is barely anything at all there. Every once in awhile it will "flare up" and I will have some flaky redder skin.

About 4-5 months ago my right hand started having some pains and tightness in it. I had just started doing landscaping after being on a computer for years. I attributed the pain to the landscape labor I was doing. It wasn't until about 2-3 months later. About 2 months or so ago now. That I noticed the fingers in my right hand were starting to bend down some. There were also strange feelings of tightness and sometimes some pain. (The pain has never been all that much to be honest, except for some reason sometimes in the middle of the night I will have shooting pains and other pain). Strange it is always in the middle of the night. The tightness is there a lot though and some minor pain sometimes.

I have done massive amounts of research since then and at first thought I had rheumatoid arthritis. Mainly because I have seen and heard more of the finger/joint damage associated with that type of arthritis. Then I read about "sausage" fingers with psoriatic arthritis and thought that is what my hands/fingers look like. (sidenote... On my dads main hand his fingers are bent all the way down like you see in rheumatoid.).

My knuckles are almost always a little swollen at least and my fingers are now down a little more. I am just starting the last three weeks to feel some of the same kinds of feelings in my left hand, but it seems to be coming on much slower.

I don't have health insurance or a lot of money at all. I finally out of wanting a diagnosis went to an outpatient clinic here and they basically told me for what will probably cost me more than a few hundred dollars. That they could refer me to some places...(I was hoping to get blood tests done there, but they couldn't do the "complicated" blood tests to distinquish between rheumatoid and psoriatic.

So basically I got reffered to a few places I could of easily found myself. I have no health insurance and was told by the person at the clinic that rheumatologist specialists are "spendy" and "high dollar" Yea..shocker. I was assuming that..which is why I was at the clinic. I have already begun to go the natural route. Which will be updated more for me as I learn more and more.

My diet has already been changed and I am taking fish oil, as well as vitamin D and a few other things. I am doing an exercise program which includes yoga as well.

I find all kinds of people talking about every kind of pain and joint deformity other than the ones I am experiencing. Which is my fingers!!! I am wondering is there anyone out there that has gone through what I am going through??? I mean are there people with psoriatic arthritis with the finger/joint disabling or damaging types??? My toes also feel a little iffy here and there... But the main deal is in my fingers right now as they are slowly bending down. Bending down pas the middle joint of the finger is where it is. Anyone else out there with this type of arthritis??? Is it psoriatic??? Thank you very much for reading. :)

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Sounds like distal interphalangeal predominant psoriatic arthritis, but it's the last joint before the nail that's affected with DIP and I'm not sure if that's where you mean. The other PsA that attacks the fingers/toes is mutilans. I've seen some pretty bad cases. You'll hear soon enough from others here.

I'd urge you to click the NPF logo at the top of this page, look under the "Resources" tab, and select "Financial Aid". The NPF has resources and links to information and programs that can help you with your insurance and/or doctor selection needs.

If you do have PsA in the fingers and toes they'll not take long to look just like your father's and there's no fixing them once done. With the speed you're describing, you should probably start working on getting some medical care as soon as possible and let the 'natural' route simmer off to the side till you know for sure. It won't hurt to try things, of course, and the exercise will go a long way in helping your symptoms. You really need to put your efforts into seeing a qualified rheumatologist and getting some treatment.

Hope things work out for you soon. I'm sorry it's hit you at a young age.

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Methotrexate 25 mg/week reduced gradually over 2years to 10mg/week plus gluten free diet helped 90 % clearance and reduced arthritis . Did not stop it "reduced It".
It worked and stll working for me ........ Good luck

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I have arthritis in both my fingers and toes. Now wear sturdy shoes with support. I get the shooting pain you describe, as recently as last night in one of my fingers. The NPF financial aid is a good resource to look into. I have found that keeping my fingers and toes as limber as possible, albiet painful, is helpful in the long run. I have had PsA since I was at least 5 years old, diagnosised when I was 14 years old.

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Yes, dealing with the hand problems right now. See "tendon issues" thread that might be helpful.

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There's no definitive blood test for PsA (if I'm remembering correctly, not for psoriasis, either - both are diagnosed after ruling out other illnesses). All that can be done re PsA via blood test is rule out rheumatoid arthritis. It is possible to have PsA without, at least yet, having psoriasis so even though your father has it, you need to see a doctor about that, too, instead of assuming a bit of red dry skin = psoriasis and therefore you have PsA. Plus you can have PsA for a decade before developing psoriasis - and some people report never developing psoriasis at all.

Try going to a dermatologist who has experience in treating psoriasis and PsA (a derm is normally less expensive than a rheumie). Methotrexate (an older chemo drug) is commonly prescribed and for many people (including me) it will control PsA of the fingers - though you'd need quarterly blood tests to make sure it doesn't do any liver damage and if you already have liver problems I doubt a doctor would prescribe it. I've so far had success (me and my dog who also takes a liver-damaging drug called Rimadyl) an OTC supplement made of Milk Thistle (Silymarin) to prevent liver damage - and additionally me taking folic acid (prescribed by my doc and I think all docs who treat PsA). Ask others here what they've done to help prevent liver damage - there may be other supplements that would work as well. Methotrexate wouldn't totally cure you (PsA and psoriasis both pretty much go away but then come back in what it called a 'flare') but it would greatly relieve symptoms and stop the damage. My 2 docs have told me they've known people who've taken Methotrexate successfully for 25 years successfully for PsA.

If you're in the U.S. be aware that there's a 'perceived' shortage of particular brands of Methotrexate right now making it difficult for patients to find the brand they've always taken and in my personal experience, one brand helps and the other doesn't. It's long out of patent and I think drug companies are manufacturing less, trying to force people onto the newer and vastly more expensive biologics - which have their own sets of bad side effects and are usually unaffordable for people without health insurance at around $30K/year out-of-pocket Though some of the drug companies 'do' indeed have programs to help with the expense of biologics as long as you're not unfortunate enough to be on Medicare (don't know if financial help is offered if you're on Medicaid). Definitely try to sign up for one of those programs if you find a doctor who diagnoses PsA and absolutely believes you have to go the biologic route.

The various ointments and creams (some quite expensive) my doc has had me try did nothing - but they may work for some people and you might be one of the lucky ones. People on this list who read this thread will no doubt speak up and say whether they've helped them or not. From what I've seen so far on this site, topicals are more helpful with psoriasis than with PsA. Diet changes help some and not others; ditto alternative meds or treatments. Everyone is different, except we all have in some way damaged immune systems.

My so-far DIP version of PsA also developed quickly (I went from a life-time of very strong and healthy nails to the nails on 3 fingers starting to separate from the nail beds within 2 weeks, and I ended up having to have those 3 nails surgically removed (hospital) because I was prescribed topicals instead of Methotrexate at first (my fault as I strongly believed handling some moldy books to toss them in a garbage bin at the request of our local library had caused me to get a mold infection). Whatever caused it, I finally had to admit I had PsA or 'something' that the Methotrexate controlled when no topical did. :>)

Nail removal is not something you would be able to handle with the landscaping work you do since it takes months for your nails to grow back (it's also quite hard - as in painful - to manage to do keyboarding for computer work, too). My nails 'did' successfully grow back and there's been no more separating from nail beds 'but' only because I don't let them grow any length at all (or they curve downwards at the ends and threaten to separate on the sides).

If by any chance you have the bad luck to have the mutilans version of PsA, you need help 'now' if you want to retain use of your fingers at all - the bone in the tips of your fingers can just flat dissolve/go away with that version of PsA and there's no regeneration of bone. Google it - the photos look horrific re what happens to your fingers.

I very accidentally cured a sausage finger myself before diagnosed back when I first got PsA. There was a tiny cut (probably a paper cut) right at my cuticle and I noticed a bit of thick, very grainy and very white 'stuff' by the cut. Squeezed it out (with pain decreasing as I did), the swelling went away and it has never come back. But I would NOT advise cutting your finger on purpose - aside from the almost certain raging infection you'd get you might also damage something in your finger, like a tendon. Perhaps a doctor might be able to do something similar in a sterile manner - check that as I'm not sure how docs handle sausage fingers. See below re trigger finger - sausage fingers aren't just your finger bending towards your palm but instead a red, swollen enough that the skin is painfully tight and in my case totally unbendable finger. There's a major inflamation causing the problem.

There's also an entirely different finger problem called trigger finger than can bend your fingers down to your toward your palm. It normally needs an operation on a tendon in your hand to fix it. I believe it is associated with rheumatoid arthritis but don't take my word on that as I'm only repeating what a friend told me who has had it affect 2 fingers and I know she does have rheumatoid arthritis. Check it out yourself to be sure. Without the operation you could permanently lose the use of those fingers as it's possible eventually you wouldn't be able to straighten them at all. My friend has one finger an operation cured, and another it didn't (perhaps the surgeon's fault) where that finger still can't be straightened out completely.

One way or another you need to get yourself to a doctor and find out precisely what your problem is. Then, as someone said above, you can start investigating possible alternative cures. I have to say that, though I'm big on alternative meds, I would not be able to type this without taking Methotrexate.

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Since Psoriatic Arthritis is diagnosed by ruling out other diseases I would worry less about whether that is was it really is and worry more about taking action and seeing if it helps. I was one of those who wanted a firm diagnosis before taking action and unfortunately if it is PsA (or many other things) time means more damage. Things got worse and I did finally began my journey of medications, diet, etc. I only became convinced that it was PsA after a biologic med started working.

If you can function enough to work it may not be a bad idea to pick up a second job for minimum wage at your local grocery store or anything with insurance while you figure out what is going on. That may just be the fastest way to treatment.

As for diet. I too made changes to my diet hoping that would help. What I have come to believe after reading a zillion posts is that the people who have significant success are those who radically change their diet... far more radically than I ever have, and I thought I had made some major changes. It's a strange topic on here b/c people who have had success what to share their knowledge with others and (many) people who haven't had success get very defensive and say they have tried it but it doesn't work. I'm generally left with the feeling that those who are the most defensive have not tried anything as aggressive as those who have had success, but rather are people like myself who made changes with no success and are frustrated. I just watched "Fat, Sick, and Nearly Dead", and although he did not have PsA, he did have an autoimmune disorder. I'm thinking about trying this and seeing if it helps. That is not to say I wouldn't strongly recommend you seek whatever medical help you can get as soon as possible, b/c I do. I just bring it up b/c you mentioned diet changes, and it is something I'm interested in. A biologic works well for me know and I will continue to use that, but it would be great to be med free if there is a healthier way.

It is a frustrating and scary process and I'm sorry you are going through this. There is a lot of information and support here. I'm glad you posted. Good luck in whatever you decide.

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does your dad have a rheumatologist (RD) he really likes? If so, it could be a good idea to suck it up financially and see that RD a couple of times. Generally these days, if you explain your insurance situation the GOOD doctors will work with you as much as they can. As stated, methotrexate (mtx) is a very inexpensive medication and even more so if you get the injectible rather than the pills. You have to take folic acid with it, but that's dirt cheap OTC, costing less than my insurance copay for the Rx version. you would have to get monthly labwork done while on it and that can add up. The thing is you want to avoid permanent damage for as long as you can, especially doing landscaping work!

It can be very difficult to distinguish between RA and PsA sometimes. I had an seronegative RA tag for 13 years until some joints that are far more typical of PsA became involved. My troubles just looked far more like RA until then and both Daddy and his mother had it. The treatments are very similar these days though and a good doctor will be very helpful in providing samples and/or assisting with the assistance programs out there.

Oh, and that shortage SAHGB mentioned above is for the preservative-free forms of mtx. The ones with preservative are still in ample supply. The primary producer of the preservative-free stuff was shut down temporarily to fix problems that had been affecting the quality and purity of their product. The FDA is looking at bringing in some product from reliable overseas manufacturers to make up the shortage until other companies are able to increase production enough to cover the shut down plant.

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Roamingator, thank you so much for the data re preservative vs. non-preservative MTX! That was the key I was missing - what the difference was and why one type was effective for me and one not.

I have now called all the local pharmacies around my smallish town (some are national chains) - and none have any stock left of Teva MTX. Do you have any info about 'when' the Ben Venue factory might be reopening, or when the FDA might be able to get supplies in from other countries? And do you know whether Teva has their own factory or was buying from Ben Venue? Teva brand is the one I've always taken (football shaped pills, instead of round).

Data for all of you taking liquid MTX. I got an email notice today from the FDA that 25mg/ml liquid MTX (both with and without preservatives) is now in short supply. Affects APP (both with preservative, 2ml vial discontinued, 10ml vial available but with increased demand), Hospira (2ml vial w/ preservative available later this month, 40ml vial w/ no preservative available in March, increased demand on both), Mylan (all 3 preservative free & all increased demand, 2ml vials limited quantity & 10ml vials available for emergency drop shipping, 40ml vials planned to be available again in coming weeks), and Sandoz (all preservative free, 2ml & 10ml vials temporarily discontinued & 40ml vials experiencing a back order).

One of the pharmacies I called mentioned sodium, roamingator - do you happen to know if that's what is being used as the preservative? And if the preservative just dilutes the MTX we receive or interacts in some manner with the MTX itself to make it less effective for some of us?

Yay!! My regular pharmacy just called me back and they found one last bottle of Teva MTX pills in their warehouse and are bringing it in for me tomorrow!

Hopefully soon an adequate supply for all of us of whichever type your body requires!

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Thank you very much for all of your replies. I really appreciate you taking time out of your days to share with me some of your thoughts, feelings and experiences. It has given me more to think about and also some encouragement to continue doing everything I can to make this better. I looked up some of the different hand arthritis and still haven't found precisely the same kind of appearance yet. I have found some images that look more so like what mine appear to be. Hopefully it is not the mutilans and so far mine don't really look similar to the images I have found for those. They look closer to a few other ones I saw under a different name I cannot remember at the moment. I have found the name of the joints that are where my bending down is occurring though and it is the PIP joint. That is where my fingers start to bend down. Ok going to get some sleep for now and wish you all a good night. Thank you again and I hope everything is finding you all well tonight as well.

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