Rifampin and Azithromycin combo for RA

[rheumforgod]

I acquired the name of the only AP doc in my city through the Road Back Foundation and have met with him twice so far. Upon meeting him, I learned that he had not read the Road Back and was not well versed on Dr. Brown's approach. This concerned me, but I was willing to try his AP approach. He began me five weeks ago on daily rifampin 300 mg and Mon., Thurs. dose of azithromycin 250 mg. My pain and fatigue increased like crazy the following day! For the last five weeks now, the pain in my hands and feet has been elevated, and now I have severe pain and swelling in a toe that was not affected prior to AP. Have also had intermittent pain in my ankles and left knee that is new. At my second appointment, I expressed my concerns to my doctor and he said that this AP approach is not low and slow and is very aggressive. He said I should try to ride it out for eight weeks at minimum and is willing to try this approach for up to six months. He said he is willing to switch to mino after eight weeks if I'd like. I haven't been able to find anyone that is on the same AP combo. I'm wondering if I should stick it out (I'm willing) or switch come eight weeks if swelling and pain has not subsided. I am concerned about the elevated pain and swelling, but if this is normal and ok, I am willing to tough it out. Would be grateful for anyone more knowledgeable about this particular combo vs. mino approach. Thank you so much!

[MMW]

Hi rheumforgod,

Did you get tested for Bartonella? I believe this combo of azithro. and rifampin is used to treat bartonella and Bartonella-like organisms.

Many here at RB say how a lot of AP drs approach treating one disease at a time, since many bacterias are usually involved and each requires their own approach. Maybe this is what your doctor is doing.  Either way, since he is not familar with Dr. Brown's book or the RB, I would still find out what he DOES know about various topics such as: microplasma, RA, lyme, and others.   This may help you have more confidence in him.

Can you ask him outright what his approach is in chosing the rifampin/zithro path and how he evaluated its use in your case? 

I would feel the same red flag if I felt my AP didn't know about Dr. Brown.  But on the other hand, if your dr. is OPEN and supportive to new information that you can bring to him, he still can be effective. 

When I showed my son's stretch marks to my dr and showed him printed bartonella pictures that exactly looked the same,  he said he never heard of bartonella being connected to such marks.  He was open enough to test him for bartonella at a local lab.  Of course, this was useless since according to online research bartonella mandates specialized testing from specialized lab.

He wasn't going to treat until I outright asked him at the next visit after the lab came back negative for bartonella.   Then he was just going to give him Zithro. only.   I told him the research said Zithro/rifampin or Cipro for bartonella.  I gave him printed info from the internet.  And he said he is hesitant to give two antibiotics at once but gave them to us anyway.   He said use the zithro first and then add the rifampin if needed.   We used the zithro for one week first and then added the rifiampin after.  He is better after one month in many ways, however in other ways we are not sure.   His skin is better, his stretch marks lighter and going away, he sleeps better.  But he tends to relapse into some bad days as he goes along.  The other day he informed me of strange inner ear pain, like an insect was biting it.  He is also experiencing something he describes as possible chronic fatique syndrome lately.  He said his knees hurt and he could not run his lap completely at track the other day because he was just too tired.  He will be taking rifampin for another month to see.  by then, maybe we will know if he was herxing.

I guess time will only tell if your symptoms are herxing.   It is hard to wait when doubts come in while suffering more and with new symptoms then we had before.  Stick to your gut instinct, though, in evaluating your situation and wether you should move on to other meds.   Our instincts often serve us best. 

I understand rifampin can cause brain confusion and side effects that a few here on RB have experienced while taking it.   You may search and see if the side effects include what you are experencing.  My son's brain fog does not seem to be any worse then before he started the meds.

I know this is not much help but at least it might help in some way.

Marianne

 

 

 

[PhilC]

[user=2625]rheumforgod[/user] wrote:

He began me five weeks ago on daily rifampin 300 mg and Mon., Thurs. dose of azithromycin 250 mg.

According to what I've read, rifampin is a potent antibiotic that can cause severe die-off reactions.

[user=2625]rheumforgod[/user] wrote:

At my second appointment, I expressed my concerns to my doctor and he said that this AP approach is not low and slow and is very aggressive.

Well, at least he knows that his approach is very aggressive and is honest about it. I would add “reckless” to the list of adjectives used to describe his AP approach.

Are you taking an NSAID or other medication to control the inflammation? With such a highly aggressive approach, it seems like it would be mandatory and a part of the protocol.

Phil

"Unthinking respect for authority is the greatest enemy of truth."
- Albert Einstein

[Maz]

[user=2625]rheumforgod[/user] wrote:

I acquired the name of the only AP doc in my city through the Road Back Foundation and have met with him twice so far. Upon meeting him, I learned that he had not read the Road Back and was not well versed on Dr. Brown's approach. This concerned me, but I was willing to try his AP approach. He began me five weeks ago on daily rifampin 300 mg and Mon., Thurs. dose of azithromycin 250 mg. My pain and fatigue increased like crazy the following day! For the last five weeks now, the pain in my hands and feet has been elevated, and now I have severe pain and swelling in a toe that was not affected prior to AP. Have also had intermittent pain in my ankles and left knee that is new. At my second appointment, I expressed my concerns to my doctor and he said that this AP approach is not low and slow and is very aggressive. He said I should try to ride it out for eight weeks at minimum and is willing to try this approach for up to six months. He said he is willing to switch to mino after eight weeks if I'd like. I haven't been able to find anyone that is on the same AP combo. I'm wondering if I should stick it out (I'm willing) or switch come eight weeks if swelling and pain has not subsided. I am concerned about the elevated pain and swelling, but if this is normal and ok, I am willing to tough it out. Would be grateful for anyone more knowledgeable about this particular combo vs. mino approach. Thank you so much!

If interested, you can follow my progress at http://rheumforgod.wordpress.com (under the page “AP Diary”)

Hi Rheumforgod,

Welcome to the RBF discussion forum!

As you're five weeks into your antibiotic therapy, this would fit with the expected early worsening, called the “herxheimer effect.” Have you been able to read the Henry Scammell book, “The New Arthritis Breakthrough,” and all the material under the Education tab on the main website?

I see you've been diagnosed with seronegative RA, so wondering if your doctor may be treating you for reactive arthritis? If so, these antibiotics would be appropriate:

New Study Asserts Effectiveness of Combination Antibiotics for Reactive Arthritis[/b]

In an article published on August 3^rd, 2010, in consultantlive.com, an online medical journal, professor of medicine, Dr. Rutecki, at the University of South Alabama College of Medicine and member of the editorial board of CONSULTANT[/i], discusses the effectiveness of antibiotic therapy for long-standing reactive arthritis. [/b]Although reactive arthritides have been thought to be the result of leftover antigenic remnants and not whole organisms, such as Streptococci, Shigella, Salmonella, Yersinia, Campylobacter, Clostridium difficile [/i]and Chlamydia, the major players in reactive arthritis, new research led by Dr. J.D. Carter of the University of South Florida College of Medicine, ?? may have identified one situation?reactive arthritis after Chlamydia infection?wherein antibiotics do ameliorate the arthritis because the whole organism persists.? [/i] Results of Carter?s studies, with three randomized placebo-controlled patient groups either receiving doxycycline and rifampin or azithromycin and rifampin or nothing at all were extremely promising. Rutecki concludes, ?Bottom line, nearly two-thirds of those treated with antibiotics for chlamydial reactive arthritis responded to the antibiotic regimen, and 22% of these patients experienced a complete remission. These results are all the more striking in light of the fact that average disease duration in the study was 8.5 years. The study was not powered to detect a difference between the 2 antibiotic groups, however. More work will be required for this question as well as for optimum dosing.?[/i][/b]

Sources:[/b]  http://www.consultantlive.com/rheumatic-diseases/content/article/10162/1631602  

http://onlinelibrary.wiley.com/doi/10.1002/art.27394/abstract

The six-month time frame is a little disconcerting though. Studies like the ones above are done within limited time frames and it's only when patients are followed longer term with the therapy that an accurate assessment of the full study cohort can be determined. Unfortunately, some docs may think that if a study is run for 6 months that must be the treatment period! So, if you think this doc won't treat you beyond this time frame, you might want to start looking further for a doc to continue your treatment for as long as you need it. There is no cookie-cutter protocol or time frame for when patients respond….it's a longterm therapy and it varies enormously from patient to patient as to when they reach remission.

A site where you will find info on these antibiotics being used for arthritis is here (scroll down to Sriram Protocol):

http://cpnhelp.org/treatment_protocols

It would be good if you can find out what your new AP doc is actually treating in terms of what he suspects are your infections. Not all AP docs are cut from the same cloth, but then not everyone is on the classic AP protocol either. Dr. Brown's basic protocol was to use the tetracycline class of antibiotics, but he also individualised protocols to each patient's needs and used a wide variety of antibiotics. If you are worsening, though, this is a clear sign that you're responding to treatment. So the pertinent question might be, is the herxing within tolerable limits for you or does your protocol need to be adjusted?

FYI, the AP Physician referral lists are peer-maintained. When someone shares with us that a particular physician has been helpful to them, open to providing antibiotic therapy for their rheumatic disease, we add them to the RBF list. So this won't guarantee a particular doctor's level of experience. However, volunteers do strongly recommend that unless the physician is known to us to be experienced in the protocols that patients call the physician to ensure they can supply the services needed. 😉

Hope something here helps!

Peace, Maz

[rheumforgod]

Thanks so much for your reply, Marianne. I have not been tested for bartonella. I will have to look into that more. I appreciate you sharing your son's experience with rifampin and azithromycin with me. I really hope he continues to see improvement. Interesting to read about the brain fog. I have actually felt lately that the RA fog I have struggled with has cleared quite a bit since taking the antibiotics. Good advice too–trust your instincts. Blessings to you and your son.

PhilC,

“Reckless”—eek! Don't like the sound of that. I'm glad to know that rifampin causes severe die off though. You could say that again! I guess I should be encouraged then, since my body is clearly reacting to the antibiotics.

In terms of an anti inflammatory-I am not taking anything that is a pharmaceutical. But I sure am thinking about it these days. I'm concerned about causing more harm to my gut though. Figure the antibiotics will do enough damage on their own. From a naturopathic stand point I take mega doses of omega 3 oils, pancreatic enzymes, and a product called Ultra Inflam X (meal replacement designed to reduce inflammation and aid in repairing the gut). I also stick pretty closely to an anti inflammatory diet. This combo has made a big difference for me. Prior to taking supplements, I had a lot more inflammation.

Thanks so much for sharing what you know.

Maz,

Thank you for welcoming me! I was really hoping to hear from you. You are an incredible wealth of information on this site and I have learned so much from reading your replies to various people and circumstances. The time you put into your replies is much appreciated. I found the study you shared with me very interesting and encouraging. Also great to read about the various protocols.

I have read the book. Loved it! It is heavily dog eared and underlined. Identified with so much in the book. I have also read a great deal on this site.

My doctor seems to be willing to work with me. So, fortunately, I don't think I will have to look elsewhere at this point. Since my blood work is great and always has been, all of the doctors I have seen just scratch their heads. They haven't known what else to call what's going on with me other than seronegative RA.

Thank you for sharing with me what you know. I am willing to tough it out at this point without decreasing dose. Would agree that I am definitely herxing since symptoms clearly increased the day after I began taking antibiotics and haven't ceased since. My concern is that the inflammation I am experiencing in my toes will impede the healing process. Will just have to see what the next few weeks bring.

Blessings to you!

[Maz]

[user=2625]rheumforgod[/user] wrote:

My doctor seems to be willing to work with me. So, fortunately, I don't think I will have to look elsewhere at this point. Since my blood work is great and always has been, all of the doctors I have seen just scratch their heads. They haven't known what else to call what's going on with me other than seronegative RA.

Thank you for sharing with me what you know. I am willing to tough it out at this point without decreasing dose. Would agree that I am definitely herxing since symptoms clearly increased the day after I began taking antibiotics and haven't ceased since. My concern is that the inflammation I am experiencing in my toes will impede the healing process. Will just have to see what the next few weeks bring.

Hi Rheumforgod,

Very clever user-name double-entendre, by the way! 😉

Seronegative RA is a confusing one, for sure, as it's a purely clinical diagnosis based on signs and symptoms with no lab confirmation. My best guess, therefore, is that your doc is treating you for reactive arthritis (i.e. reacting to an infection). Psoriatic arthritis and Anklylosing Spondylitis are both reactive arthritides and these, too, are hard to diagnose without genetic haplotyping (HLA B27 marker), but even then some folk can present with the symptoms but not carry the gene. It's a bit confusing, isn't it? 😕 I think the term “seronegative RA” is a kind of junk diagnosis, really, as they don't really know what it is and sometimes people get misdiagnosed with it and find later they had AS or PsA all along.

Nevertheless, the abx you're on are a good start and, although I'm not a doctor and unable to tell you if you're herxing or flaring, the timing of starting your abx and your worsening does sound indeed like herxing. On the main site, there are labs that can be run to check for this, if your doc is open to this type of monitoring:

_____________________________________________________________

“The Herxheimer flare is the first indication that the antibiotic is reaching its target, and therefore considered a good sign.

When the severity of the arthritic condition begins to lessen, either from a spontaneous improvement or as a result of the continued treatment with carefully measured doses of antibiotic, a greater tolerance for the antibiotic is noticed and larger doses are tolerated without a return of the Herxheimer flare reaction. If however, the dose has been increased too rapidly at any time, the initial flare reaction may occur again.

In the evaluation of these exacerbations, the physician must remain aware of the frequent disease flares from other causes, and he should attempt to differentiate from those which may be drug induced.

Differentiating between a Herxheimer, an RA flare and an allergic reaction to the drug –

Laboratory tests can help differentiate between a worsening of disease (RA flare), a Herxheimer reaction to microbial toxins, and an allergic reaction to medication.

1. WBC will elevate in a Herxheimer and lower in a flare. [/*:zhbyxy6y]
2. A Herxheimer will also exhibit a coincidental elevation of SED rate, gamma globulin and total globulin, and a fall in serum albumin and hematocrit. Patients who exhibit this flare reaction accompanied by anemia, depression of serum albumin, elevated total globulin and gamma globulin are probably reflecting a more intense reaction pattern to anti-L substances than in hematologically mild cases. [/*:zhbyxy6y]
3. A marked increase in eosinophils (for instance about 30%) is an indication of an allergic reaction to the drug.” [/*:zhbyxy6y]

____________________________________________________________

Really experienced docs don't need labs to confirm what they already know…that is, that they use the herxheimer reaction as a clinical sign that the abx are reaching their target. 😉

Question is…is the herxing you're experiencing tolerable? If not, you may need to either add in an anti-inflammatory for a while to get you through the worst or tweak your protocol a bit with your doc.

Rifampin is used longterm for TB patients…months upon months. It is a pretty heavy-hitter and you need to keep a watch on your liver enzymes. Are you enjoying the tangerine-tinged bodily emissions? I was on it for several months to treat bartonella, a coinfection of Lyme disease, but was glad my doc warned me of the color change! :roll-laugh:

Hang in there, Rheumforgod…it takes many years for us to get this sick and the immune system to crash. It takes a good long while to turn things around, but sounds like you're doing a lot to support your road back already. Have you started in on doing any detoxing to help your body get rid of the toxins a bit faster?

Peace, Maz

Peace, Maz

[rheumforgod]

Fantastic information on the differences between herxes and flares and ways to differentiate. Thank you! Will be seeing my doctor in less than two weeks. Plan to talk to him about the labs.

“Junk diagnosis” is certainly a great way of referring to my diagnosis. I have swollen toes and a puffy pinky right now, but my CRP is zero! It is comforting to know that there is some rhyme and reason as to why my doctor has chosen the AP route that he has though.

I have been working with a doctor of naturopathy that is also a pharmacist for over six months now and he has also advised me to have my doctor keep a close eye on my liver enzymes. (I discovered him on satellite radio and he has been a critical part of my wellness.) I am taking supplements to support kidney and liver function. As far as helping my body detox–I take regular epsom baths and dry brush my skin and rebound to stimulate lymph system, and I drink a crazy amount of water everyday with 6-8 grams of buffered vitamin C. Which, as you know, makes for some frequent and colorful bathroom visits due to rifampin. 😛 Someone recently suggested adding rubbing alcohol or peroxide to the bath. Haven't tried that yet. I've also read about a lemon, olive oil drink on this site, but have yet to try that as well.

It always helps to read about what others have gone through and are going through on this site. Sometimes the pain can cloud the thinking for a bit. 😕
Thank you so much for the encouragement. It has been a blessing.

[Bill]

Maz,

Can arthritis be reactive when there is a high RA factor, CRP, sed ect?? Hmmm, I did get a rare but whopper of a chest cold about a month before the RA hit.

 Thanks for all you continue to do, much appreciated.

Bill

[lynnie_sydney]

Bill – apparently RF is usually negative in reactive arthrides but other markers often elevated.  Wonder if your “whopper of a chest cold” may have been Chlamydia Pneumoniae (CPn)? Lynnie

Blood tests such as a “sedimentation rate” may be obtained to document the presence of inflammation in the body. The rheumatoid factor, which is typically present in rheumatoid arthritis, is usually negative in reactive arthritis. The HLA-B27 gene marker blood test can be helpful, especially in the diagnosis of patients with spine disease. http://www.medicinenet.com/reactive_arthritis/page3.htm

Be well! Lynnie

Palindromic RA 30 yrs (Chronic Lyme?)
Mino 2003-2008 100mg MWF - can no longer tolerate any tetracyclines
rotating abx protocol now. From Sep 2018 MWF - a.m. Augmentin Duo 440mg + 150mg Biaxsig (roxithromycin). p.m. Cefaclor (375mg) + Klacid 125mg + LDN 3mg + Annual Clindy IV's
Diet: no gluten, dairy, sulphites, low salicylates
Supps: 600mg N-AC BID, 1000mg Vit C, P5P 40mg, zinc picolinate 60mg, Lithium orotate 20mg, Magnesium Oil, Bio-identical hormones (DHEA + Prog + Estrog)

[Bill]

Lynnie- It is a possibility. I did have some severe bouts of pneumonia as a young child as well as asthma and allergies. But I outgrew all that and became quite strong and resilient. Rarely got a cold or flu, excellent health and physical condition. However that particular cold was a doozy. And while I had taken zith a few times in prior years with no problems. This time it just seemed to wipe me out on all levels. I have always thought that may have been a very powerful herx because it just waylaid me for 2 weeks on all levels including mental,ect. I found that very unusual.

 On the other hand when I first figured out I had RA my factor was 769. Crp-90.00

Sed- high ANA positve. By last December after about a year and a half of mino plus my natural protocol Ra was normal. Crp-8.00 AnA-negative. So a lot of progress has been made. But I'm ready to root out the last vestiges of whatever it is and totally recover. Would the prior blood work with high RF be unlikely to be a CPN indicator or not necessarily??

Thanks,

Bill

[Maz]

[user=15]Bill[/user] wrote:

Can arthritis be reactive when there is a high RA factor, CRP, sed ect?? Hmmm, I did get a rare but whopper of a chest cold about a month before the RA hit.

Hi Bill,

My doc said an interesting thing when I first went to see him. He believes in infectious causes for RA and so he said, in effect, that RA is a “reactive arthritide”…that is, the body reacting to infection.

The classic reactive arthritides are, of course, caused by infections such as the chlamydias (pneumoniae and trachomatis, Streptococci, Shigella, Salmonella, Yersinia, Campylobacter, Clostridium difficile, klebsiella, etc) and are often seronegative. Also, the more defined arthritides, like psoriatic arthritis or anklyosing spondylitis. However, if one believes in infectious causes for rheumatic diseases, then it's not unreasonable to say that these are all “reactive” in the sense that the body is reacting to infection.

Bill, in the upcoming RBF eBulletin, there is an article which discusses anti-CCP and the connection to infections. Should be going to your email inbox within the upcoming week if you have signed up for your free copy on the main Road Back site. This marker is said to be highly specific for both diagnosis and prognosis of RA and yet it has also been found to be positive in various infectious states. RF is well known to be positive as a result of some infections. Infection will cause inflammation in the body, as it's the normal response to wall-off infection and target it. As such, CRP and SED can also be elevated in folk who don't have rheumatic diseases, but just have an acute passing infection.

So, yes….if one believes in infectious causes for rheumatic diseases, these markers will be elevated. Anti-CCP and RF are antibody tests, after all. 😉 It's just that mainstream medicine still believes rheumatic diseases to be “idiopathic” (of unknown etiology or cause). This is why these antibodies are referred to as “auto-antibodies,” which are antibodies directed at self and that our diseases are “auto-immune” (an errant immune system attacking its own tissues). But, this does not account for hidden, intracellular and pleomorphic infections which the body senses are there and goes after, but which it is having trouble finding due to clever cloaking systems used by these bugs. The following video is about Lyme, but the mechanism for many chronic infections likely works in a similar fashion:

http://envita.com/sections/disease/lyme/default.aspx

Why some folk are seronegative and some seropositive for RA is a good question that I don't know the answer to, except that it may be related to genetic predispositions or perhaps infectious mix.

The above is just my layman understanding of it all, Bill. 😉

Peace, Maz

[Bill]

Maz,

Well I certainly believe in infectious causes of RA and my doctor and heme are starting to believe as well!!

Maz thanks so much for the informative response and the video. Yes I do understand it is only your lay mans opinion. In my opinion it is worth it's wait in gold. Thank you so much for helping me to understand it a bit better and pointing me towards some additional areas to check out. I will be looking forward to the news letter.

You and the other volunteers have really brought this board forward in an amazing way. You are all a Godsend.

Thanks to you all…:)

[judy cash]

RheumforGOD,

I just wanted to give you a little of my experiences with AP. I have RA and got started on AP soon after getting my diag. I started out  and continue to take 100 mg. Mino., twice daily.  In the first several weeks after starting, I felt worse than I had ever felt before starting AP. I was so bad that I had to use a walker and was unable to get up from the bed by myself, or walk to the bathroom.   Needless to say “I was scared to death, I thought what have I done to myself “. But then I realized that, to feel that bad was a good sign that AP was wroking, killing off the bugs. I did tough it out, and after about 6 weeks, I began to feel better and better. Before AP I was getting so bad so fast. I was unable to hold dishes, to put in the cabinet. I couldn't even lift my arms on some days. If I could manage to get some potatoes peeled, the next day my hands hurt soooooo bad that all I could do was sit in the recliner, and cry, and hold my hands so they didn't move.  I had to use braces on my wrists, just to drive……I am so GRATEFUL that GOD allowed me to find this great site. I am so GRATEFUL that I began AP. I am not in perfect condition, but soooooo much better than I was before AP.    I can do almost anything that I need or want to do now. I still get tired out pretty easy, but I can manage with that…. I hope this can give you some encouragement . If you have any questions, just let me know.

Best of luck to you,

Judy

[rheumforgod]

Judy,

I am so touched by the fact that you took the time to share your experience with me and encourage me. I truly appreciate it. I was very much encouraged. Your situation sounds so similar to mine and I see you have children as well. I have four children myself. You know the struggles we've faced to meet the needs of our families despite the pain and fatigue. And as moms, we can be downright stubborn sometimes when it comes to getting things done, when we really shouldn't be doing anything to aggravate the pain. I really related to the potato peeling incident :P. I've had days when I had to ask my husband to peel the potatoes for dinner due to painful fingers. I hate days like that and I hate asking even more. But I've learned the hard way, that if I don't accept help sometimes, I pay a heavy price. He is a sweetheart about helping though.

I have actually begun to feel a slight improvement in my feet and wrist in just the last couple days. Holding my breath though. Of course, other areas are inflamed. But like you and others have said, that's a sign that things are working. I am almost right at the six week mark. Although I was diagnosed over a year ago and my old rheumatologist wanted to put me on steroids, a biologic and methotrexate–I resisted and took a mostly naturopathic approach until discovering AP. I first had to wean my little one. I wanted to tough it out until he was over the year mark. People judged me for it. But that was a decision I will never regret. My other three were long time nursers and it was heartbreaking to have to wean my little guy to start med.s. But God was amazing and gave me an incredible peace about the timing. I think AP is truly the best approach to start with. I'll take this approach over a biologic or a chemo drug any day. Praise God that AP was your first line of defense and you have seen results!

I discovered AP through a blogger known as Southern Gal with RA. Will be forever grateful to her for sharing her story. She led me to the Road Back which I've discovered is a phenomenal place to learn and connect.

Many blessings to you!
Rheum for God

[rheumforgod]

Maz,

I had to get up early this morning to write you. Prior to your reply to me, I had never heard of PsA. I was up late last night researching more on reactive arthritis and Psoriatic Arthritis. As soon as I started reading about PsA, I just about jumped out of bed. If you ran down the symptom list, I could go, “check”, “check”, “yep, have that too”. I have had strange little patches/rashes on my face that my derm has biopsied and scratched her head over only to come back with the labs saying it's some form of dermatitis. Well, they are flaky little patches, which incidentally suddenly disappeared two weeks into AP. I have sausage toes, back pain along my spine that is sometimes unbelievable, heel and tendon pain (was one of my first symtoms), the list goes on and on according to what I read on the National Psoriasis foundation. The kicker for me that makes me feel like that is what I am dealing with without a doubt is what has recently been happening to the nails on my toes and now my hands. I thought it was a fungus issue and have been treating it unsuccessfully for months. The photos of people with psoriasis of the nails look exactly like mine. Now the big question is whether the protocol I'm on (which sounds fantastic for reactive arthritis) is appropriate for me. I have been experiencing major flares with my ankles and have that new sausage toe to add to my others. But I have seen improvement in my wrist and morning stiffness. From what I've just begun reading on this site, people have used the mino approach. I see my doctor on Monday and can't wait to see what he says. Maz, you have steared me to a diagnosis. I am beside myself. It's a bit overwhelming to finally feel like you can be classified. A bit emotional to read about the effects PsA can have. But I'm thanking God for you. I think I can throw my “junk diagnosis” out the window. May your day be richly blessed. Will keep you updated. 🙂

Many Blessings,
Rheum for God

[Author]

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