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Splenomegaly; fatty liver;
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Splenomegaly; fatty liver;

Hi!  I'm about to see a GI specialist next week and would like to know in advance some of the key questions or tests that need to be done.

I'm in my 40's (female) and I have psoriatic arthritis.  I was on Naproxen (600mg/3x day) for a couple of years.  I've been off it for the past year.  I'm currently on MTX (8 pills per week) and Humira.  I've been on hydrocodone/apap for the past six months for pain.  A bad PA flare kicked in after knee surgery last December -- and the pain and inflammation have been intense.  The Humira/MTX combo wasn't working to halt the flare, so they just upped the dose of MTX from 6 to 8 -- and are thinking of switching me to Remicade next month.  They also gave me a cortisone shot recently.  I'm not sure if that or the increased MTX helped the flare, but some of the fatigue was reduced a bit this past weekend.   I am overweight and it's not unusual for me to go up or down 8-10 lbs. a day due to inflammation and swelling.  I do have a severe case of sleep apnea (which isn't given me as much trouble since I starting using CPAP machine last fall.

The problem is the splenomegaly.  It's currently considered mild to moderate (16 cm).  I also have a fatty liver.  They just did a CT scan (without contrast) and ruled out tumors.  Cervical ultrasound came back clear.  Some of the RBC numbers are low (RBC - 3.8; Hemacrit - 33.4; Hemoglobin - 11.5).  My CRP rate is extremely high -- 22.

The doctors think there's definitely some underlying issues.  Obviously, the meds I'm on can cause lymphoma and open me up to other types of infections.  I had an uncle with Hodgkin's disease (in his late 20's) and there's heavy cancer in my family (breast, uterine, among others).  

Any thoughts?  I would like to make sure that this is addressed before it gets worse.  The pain when the spleen presses on the stomach has been getting worse.  I've been nauseous for more than three months, which is horrible.  
I've been fatigued, but that might be attributable to PA or sleep apnea as well.  I've also seemed to have more gas lately, which can be painful.  I rarely have extensive gas so this is a bit unusual for me.

I'm really not someone to worry about aches and pains. But the combination of joint pain, splenogemy and nausea has put me at the end of my rope. I would really love advice on next steps.

Thanks!

Pat
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