potential additional diagnosis and questions about MTX

Hi all,
I've been getting by pretty well the last few months aside from some nasty migraines. I've adjusted to the aches and pains that come and go. Sometimes they are intrusive and but I've come to the "at least they aren't Crohn's" conclusion and try to ignore it. Well, my rheumatologist appointment today kind of brought all of this up again and I'm not quite sure what to make of it all. She said she believes I have psoriatic arthritis. She has said this in the past but there has always been a question as to whether it was that or a number of other things. She is more sure of it each time I come for a follow up. Unfortunately there are no labs or anything that confirm this but she's convinced based on little things I hadn't been paying attention to and the location of the body aches that that's what it is and it's uncontrolled by the remicade. I don't have any rashes though so I'm a bit confused. She wants me to swap the 6mp for Methotrexate but I'm still just not sure since I feel better than I did, I don't want to compromise the gains. What has everyone's experiences been with MTX combined with remicade? She also mentioned that MTX is an issue if I wanted to have kids and that we would have to discuss this later and didn't go into details. Does any one know what the risks are of long term use of it before having children? Im no where near interested right know but if I should decide to have children at some point I'd rather avoid meds that would conflict with this. Im going to think it over for a few months and speak to the GI. She also mentions possibly increasing the remicade even though its above the target level.

L, you are right blood tests alone cannot dx RA. If the dr did an ESR or CRP that came back elevated, all that says is you have inflammation somewhere in your body. Crohns can cause those to be elevated. When the dr did labs did she order an anti-CCP, this one is used when looking for potential RA.

Also, not sure where your pain is located, however, RA usually strikes the fingers to hand & toes to feet first. It does not strike the larger joints in the beginning. Your rheummie should do either MRI's of your hands or ultrasounds to check for joint damage in your hands & fingers.

Knowing you want children at some point I would want more definitive testing done before entertaining the thought of adding a drug.

I am not sure what your infusion schedule is for Remicade but you may consider talking to your GI about moving your infusion up & do that a couple of times to see if it helps with the pain. I ended up going every 4 weeks for my infusions & it helped with the joint pain.

I hope you get some answers.

I don't know often you get

Thanks All!
I really don't even know for sure if this is psoriatic arthritis or what. I have never had any major rashes so it seems weird to have this as diagnosis. She was going on some swelling in my knee, some dandruff in my hair( apparently she could see very minor changes to my scalp that are undetectable to a non doctor), little dry skin on my elbows (not red though- don't a lot of people have this?), and the location body aches and pains. I did a grip test and my hands hurt quite a bit from it.

Notsosicklygirl- that sounds horrific! I have always had trouble sorting out what problems are from illness and which are from the medications so I'm not really looking forward to changing anything right now.

Straydog- all my levels are within normal last time they were checked but they believe there is still inflammation despite this being okay. From what I was told by another doctor, being on biologics can change whether the lab tests show anything. The only thing that was off is the Complement. I'm very confident the crohns is not active right now. I agree, I forgot about MRIs for tis issue. The previous Rheumy I went to wanted to do them a few years ago but then I was feeling a bit better after I stopped humira and got caught up with other life issues and never got back to them. This doctor has not suggested them. It definitely bothers my hands, sometimes my feet and ankles and knees. Most frequently the upper back around the scapula which I was told was caused by the PsA attacking the soft tissue. Yes, thats going to be my first way of approaching this-seeing if the remicade can moved or increased.

Gutsygal- Thanks for this information!yes, its definitely scary with any of this meds. what freaked me out a bit was this- She said how we would have to talk about the future with children and this medication at some point. I told her how I was aware that you need to be off of it for a few months since my friend's husband takes it and I heard a lot about their experiences. She said yes , but its much harder for women. I so wish I had asked her what she meant by this! I'm going to go with what your GI said because thats basically what I see in all of the literature on it and Im really not sure what to make of that appointment.

Thanks again all, for helping me talk this through! The GI usually has the winning course of action so I think I'll hold off on any choices until I speak to him and my pcp.

@cupcakespinkgal Thank you for sharing this info! I'm thinking now the doctor I went to was referring to birth control when she said we would have to discuss things. What made you stop taking it- lack of effectiveness? Im still not sure whether I will go through with switching meds but this is good to know!

@cupcakespinkgal Wow, that's terrible! Yes, I started remicade with 6mp and I wouldn't doubt that helped it success.