How do I know if my condition is Psoriatic Arthritis or Fibromyalgia?

I heard you on Doctor Radio today, great program. I am 50 years old and about at age 30 I was diagnosed with Fibro. Recently with the insistence of my DPM (Foot) I made an appointment with a Rheumatologist and she immediately (after blood work returned) diagnosed Psoriatic Arthritis not Fibro. I have started on methotrexate, 2.5 mg orally (8x one time a week). My question. How do we know it is Psoriatic Arthritis and not some other auto-immune disease. The treatment is very troublesome to me and I need to know I am being treated correctly. I love my new doctor, she is great but it does give me pause to think I'm taking a drug that has so many harsh side-effects. Does one ever know they for sure have Fibro or PSA or other diseases. Do you have a definite diagnosis that you provide that leaves no doubt as to what one has? I've always had various auto-immune problems in my life so it doesn't surprise me on any diagnosis but I am concerned. So. PSA or Fibro - how does one really know?

Answer

Glad you enjoyed it! With psoriatic arthritis, you will often see multiple "pinprick like" changes in the finger nails as well as the classic skin changes. Red swollen joints also are not fibro but rather usually infectious or auto-immune. I suspect that the blood tests ruled out other causes of joint pain (eg- gout or rheumatoid arthritis) rather than confirming PSA. If you have widespread pain and insomnia, you likely also have fibro even if psoriatic arthritis is present (which can trigger a secondary fibro). In my patients giving what you describe, I would treat with SHINE first regardless before going with the stronger medications, but I defer to your rheumatologist. If you respond well to the methotrexate, it makes sense to stay on it, but if not, or if you get a partial response, consider adding in or substituting SHINE. Unfortunately, there are no tests here (and precious few in general) that give a "100% certainty" answer. 

L&B,
Dr. T