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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Suggest treatment for psoriatic arthritis

i have psoriatic arthritis and 2 years ago I suffered from pulmonary embolisms. Ever since the embolism I have noticed that my right foot is purple on the top close to my toes and sometimes the ball of my foot hurts so bad that I can barely walk. Putting on shoes sometimes is extremely painful and I am worried about my foot. my family doctor says it is vienous pooling and my rhumatolgist says it is the arthritis. any ideas cause my husband is really worried about it and I am tired of being uncomfortable. I have varicose veins as well, and most of my arthritic symptoms are in my knee. however I am sore in my hip and shoulders and hands as well. I take the following medications, warfarin, celexa, synthroid, and naproxen (as needed) also creams for my psoriasis. I was on methotrexate however I stopped taking it because I didn't feel as though it was helping at all. I feel frustrated and tired all the time so any help you can give me would be appreciated. Thanks


Thu, 30 Jul 2015
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Orthopaedic Surgeon 's  Response
Hello,

I have studied your case with diligence.

When such patients come to our hospital I advise them blood test like ACCP, ESR, HLA B27.

It may be seronegative spondylo arthropathy.
NSAIDs, DMARDs (disease-modifying anti-rheumatic drugs) are sometimes prescribed in more severe cases. These include methotrexate and sulfasalazine.Corticosteroid injections for severe pain and inflammation in a specific joint.TNF-a inhibitors, a newer class of biologic medication.
Hope this answers your query. If you have additional questions or follow up queries then please do not hesitate in writing to us. I will be happy to answer your queries.

Do colour doppler both legs to see vascularity.
Wishing you good health.

Take care.
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Rheumatologist Dr. Somya Jain's  Response
start methotrexate and if u feel it's not effective u may switch over to leflunamide. may consider sulfasalazine if peripheral arthritis is troubling u. avoid painkillers. if basic condition not resolved u may consider biologics
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