Fibromyalgia and Psoriatic Arthritis

Hi Katherine, yes I'm the same as you. I've suffered with psorisis for 40 years. 2012 I was diagnosed with Fibromyalgia then sept 2020 diagnosed with psoriatic arthritis. An important point I want to make is for the last 10 years I've been on methotrexate for my psoriasis as topical treatments no longer work for me. 2012 I was diagnosed with fibromyalgia after a number of years suffering with joint/muscle pain,severe tiredness, brain fog....the list goes on. Over 9 years I was referred back to Rheumatology with increased pain , slight swelling of certain joints bit was told it was just the fibromyalgia having a flare so would tweak my meds. The methotrexate requires 3 monthly checks with my dermatologist to check bloods are ok. Over the last year due to covid my checks became telephone consultations with a specialist nurse. April last year she asked if I would reduce the methotrexate as my psorisis was well controlled. I agreed and slowly reduced my weekly dosage from 20mg to 12.5mg. By june I was suffering severe pain in my left hip, my fingers and wrists, the fatigue became much worse to the point I was sleeping more and more during the day. By July my psoriasis had also inflamed. I contacted my G.P with regards to these symptoms, I also decided to begin increasing my methotrexate. G.P arranged bloods which shown raised inflammation markers indicating arthritis so referred once again to Rheumatology. By the time my appointment came through the symptoms had calmed however the Rheumatologist decided to arrange hand and foot xrays plus an MRI as I was still suffering with my hip. These shown fluid around the joints. She went on to say I have psoriatic arthritis and the reason it had been inflamed was due to me reducing the methotrexate- although this was for my psoriasis this treatment is used also for arthritis . The reduction had caused my joints to flare but also to say that as I had chosen to increase the meds due to my psoriasis flare this in turn calmed my joint inflammation. I'm now on a stable dose of 20mg a week to keep both my psoriasis and arthritis under control.

Hi Nanafran, Thanks for your reply. May I ask a bit more about your FM symptoms? To be honest I am unsure how you definitely know it is FM causing the pain and not the arthritis. I feel like my rheumo is relying solely on the MRI to suggest FM is causing the pain in certain places rather than the PSA but I have heard that MRIs aren't bullet proof and can show nothing but you can still have PSA. So, I am feeling rather confused about it all! Will hopefully be seeing one of the nurses in six weeks time so I am hoping they can explain things in more simpler terms. Thanks in advance

hi Katherine, I was diagnosed with FM approx 12 years ago after suffering a back injury at work. it gives me alot of muscular and ligament pain widespread. there is a general spread with fm pain and i usually feel it in large areas and it moves to different areas on different days. I have a baseline of `normality` but when it flares up i can feel quite `fluey` and fatigue and fog increases. I was diagnosed with psa last year in the first lockdown and it is completely different feeling to the fm. Yes the fatigue is similar and all consuming. but the pain and tenderness is much more specific to the hands and feet where it is flaring up in me. i do also feel my knees and neck are involved in this too, again its more the ligaments/structures of these joints that the psa affects rather than the large muscles. the psa gives my affected joints stiffness, achey pains, swelling, redness. the fibro pain is just an all comsuming more whole body experience, random places ache and hurt, sensitivity increases to any bumps or knocks, even to sound and heat or cold. the fatigue for both is just like a battery has suddenly drained and theress nothing for it but to just lie down. it has taken me a very long time to `pace` my activities and not just go hell for leather. use everything ini your arsenal to help with just getting through the day....pain relief. heat. cold. support braces etc, walking aids, household pick up sticks and grip bars and bath mats etc etc.

Thanks Nic, that is really helpful. I have to say that I don't really have this whole body pain that is often described with FM (which I know is good and I feel for you so much) . I have isolated areas but I could not tell you if it was FM or PSA. I do experience similar pains in different areas. For me it is my thighs and hips, inner leg at roughly knee level, coccyx pain, sit bone pain, lower back pain, mid and upper back pain, as well as newly developed jaw pain. However, I wouldn't say I necessarily experience pain all the time in all these areas but some of these areas are very sensitive to the touch/pressure which is why my rheumo suspects FM involvement (as well as lack of inflammation on the MRI in some painful areas) and I get episodes where I experience intense stabbing pains in some places (which was really bad in my low back when I started experiencing them years ago) and just can't do anything. Most of the time the pain is dull and achy though. My upper back can also be stiff in the morning. Also, in regards to my back, I think some of the pain is mechanical and perhaps lack of muscular strength. Definitely feel fatigued but luckily not as bad as others. Don't feel any mental fog but my short term memory is not good but then I had a lot of epileptic seizures so who knows what damage they caused and the drugs I take for it aren't small fry. Thanks for sharing your experience. It helps me understand it better as I am still not convinced about the diagnosis.

Hello again Katherine, sorry for the late reply. I had surgery a month ago and the recovery hasn't been good . Going back to your question I feel that the fm pain is more muscular where the arthritis is more from the joints. For instance when I was experiencing the awful pain last year, it was mainly my left hip, to the point I could barely walk, it was really stiff especially in a morning. Another sign was joint pain in the small joints of my fingers like a constant ache similar to hot aches and again stiffness,,this also shown in my right large toe and back of both my heels although I say I've had only slight swelling in just one finger!. I also believe the chronic lower back pain is more arthritis than fm as at it's worse the pain travels up my spine and into my neck. With regards to your jaw pain, I've been diagnosed with TMD - temporal joint disorder by my GP and been referred to maxifacial . My gp explained it's a type of arthritis of the jaw. When it comes on its extremely painful, the pain starts at the temple and goes down the side of my face into my ear which makes it feel like awful earache,my jaw clicks but not had the lock jaw that can appear with this. I hope you've seen the specialist nurse by now and they've been able to answer more of your questions from a professional view x

Thanks Nanafran. Sorry to hear about your operation. I hope things are starting to go in the right direction for you. Yes, I have read about TMD and I believe you can get it with FM and PSA which makes things more complicated. For me it is left sided and feels like it effects all of the jaw and it can can go into the cheek bone. One time my ear hurt a little too. No clicking or locking though and the pain fluctuates a lot for me. It was quite bad last week but much better this week. It is odd, I don't remember my rheumo saying anything after I described it but maybe he just saw it as further evidence of FM or maybe my memory is going! Perhaps need to highlight it again when I next see him. Yes, the one place that is definitely arthritis related is my hips - apparently I have inflammation in the tendons around there but I luckily have only suffered stiffinness a hand full of time, most of the time its soreness in the thighs with the occasional sharp pains. Still no appointment for the nurse so will probably have to chase. Thanks again

Sounds like our old autoimmune 'friend' enthesitis. This is related to psoriatic arthritis and causes similar symptoms to fibromyalgia. You can have the full set at times although it comes and goes with me. Have a look here for further information: https://www.arthritis.org/health-wellness/about-arthritis/related-conditions/physical-effects/enthesitis-and-psa I found this useful but make up your own mind. I hope your TMD is better.