Psoriasis/Psoriatic arthritis

[suezeeque]

Before I was diagnosed with HCV I had a bunch of different things going wrong with me.  In late November 2009 all the lymph nodes on the back of my head swelled and were terribly itchy.  It seemed to happen every time I ate, about 45 minutes after eating.  Sometimes they would swell up so much I had just one huge mass of swelling on the back of my head and over my ears.

That went on until the following January.  The very same day that stopped, other things started.  I had crushing pain in my chest and couldn't even swallow water.  I was only able to eat once every other day.  I also started to get rashes that started between my fingers and over the course of a couple of hours would cover my entire body.  It was hell.  I lost 40 lbs in a few months.

I was referred to several specialists in an attempt to figure out what was wrong with me.  I saw an internal medicine doctor who sent me for every test under the sun.  Gastric emptying study, a test for cortisone somethingerother, a zillion vials of blood taken (which is how I was diagnosed with HCV), a few CT scans, MRI (one of the CT scans and the MRI while I was hospitalized briefly comtemplating whether or not they would just insert a feeding tube), upper endoscopy, Honestly, I can't even remember all the tests I had.

I was referred to a second gastro (the first one was useless) who sent me for a test to measure the contractions in my esophagus.  I was then diagnosed with vigorous achalasia.  This was a YEAR LATER.  I lived with this crushing chest pain and not being able to swallow for a YEAR.  I now take a high blood pressure med to relax my esophagus so that I can eat.

I was also referred to an immunologist who diagnosed me with dermographic urticaria.

I'm sorry for writing a novel but it is getting to my concern about interferon!  ;)

This past Thursday, after getting out of the shower, I was covered in small red spots.  I had a bunch in the crook of my left elbow and all over my lower legs.  I swore it looked like ringworm!

So while googling ringworm images to compare my spots to pics of ringworm, I see that psoriasis looks the same.  I start researching psoriasis...  Damned if I don't have several symptoms of psoriasis.  The ends of my fingers have had a buildup of excess skin for years.  I have patches of rough skin on my elbows that never go away, no matter how much moisturizer I use.  My rashes are always in the same places, my shoulder blades, lower back, inside elbows and lower legs.  

Then the psoriatic arthritis...  The last joint on my left pinky finger is permanently bend.  This has happened over the past few years.  I also had lower back pain for years, an MRI several years ago revealed some changes to my sacro joints.  

Then I also read that people with psoriatic arthritis sometimes have dysphagia.  My esophagus troubles?

I have never told any doctor that all of my troubles came exactly 4 weeks after I had an H1N1 shot in early November 2009.  I don't want to sound like a crazy "immunizations are bad" person.  ;)  I've had a flu shot every year because I have type 1 diabetes (also an autoimmune disease!).  Never had a problem...

So here is my question - IF I have been misdiagnosed with vigorous achalasia and dermographic urticaria, and I actually have psoriasis...  This can be exacerbated by interferon treatment, correct?

At about week 20 into treatment, the itching became unbearable.  I blamed the drugs...  But now I am 12 weeks post early EOT and it's not getting any better, it's getting worse.  The hip pain, peeling fingers, esophagus spasms, itching so bad I have to immerse my feet in ice cold water when I get home and take my shoes off...  It's awful.

I have an appointment with my gastro in a week.  I should probably ask him for a referral to a dermatologist.  

My father has rheumatoid arthritis but I know I do not, I had some blood test that was negative for that.

[suezeeque]

Psoriasis isn't *just* an autoimmune skin disease.  Perhaps anyone with experience with psoriatic *arthritis* might comment.

My brother has psoriasis.  I know what the type he has looks like.  I also know there are other types that DON'T look like what he has.  I guess I can't really see him telling someone that they don't have psoriasis just because it doesn't look like his?

No ornamental grass at the garden center yet.  Boo.

[jules2551]

Nice bedside manner!  NOT  Your way out of line here Hector

[suezeeque]

Thanks pooh and flcyclist.

I have no belief that treatment caused it.  I had this skin issue before treating.  Before being diagnosed. even.  It just seems to have worsened while treating and continues to be worse than it was before treating.  :(

I'm going to see if I can get one of the several nodules on my elbows biopsied...  Sheesh.

In the meantime, think I'll go buy some ornamental grass, spend the rest of the day in my back yard and keep telling myself that it's all in my head.

:p

On a positive note, I feel much better than I did 3 months ago, my hemoglobin and all that good stuff are normal again.  

I had my 12 week EOT tests done on Thursday.  I'm not overly optimistic about the results, though...  

[ceanothus]

Your rash looks exactly like the one I currently have from the ribavirin/interferon. I'm  24 weeks into a 48 week plan, triple tx with Incivek. I've seen other posts that would indicate that the rash can continue for some time after tx, and while 12 weeks is a long time to still be getting new outbreaks, it may be that your pre-existing conditions cause it to take longer to settle down again. A dermatologist is definitely in order. Mine prescribed Triamcinolone ointment applied twice daily to the rash and Averno's Eczema Therapy cream applied twice daily everywhere. The combination has been very helpful. Good luck.
-Saelon

[pooh55811]

Per the Pegasys insert, Interferon can exacerbate autoimmune disorders.

You said that your rash and itching got a lot worse about 20 weeks after starting treatment. You also said the rash and itching continue 12 weeks post treatment, along with other symptoms. I don't know what you have, but if it is an autoimmune disorder, I would suspect that the Interferon could have exacerbated it.

(I too have been concerned about this possibility because autoimmune disorders run in my family. And, I already have asthma and a ton of environmental sensitivities. My dermatologist did a hive biopsy and also ran a bunch of autoimmune disorder tests when I presented with a generalized rash of pinhead sized red bumps, hives, and flat hard red blotches the size of a dime or penny. Lucky for me, even though the ANA was positive, the ENA panel tests were all negative for specific autoimmune disorders.)

I surely hope the docs can figure out what is causing your symptoms so you can be treated appropriately and get some relief.

[flcyclist]

When you mentioned "looked like ringworm", I thought I'd share my experience.  About 5-6 weeks into tx with SOC I began to develop a rash, mainly on the back, but also on the thighs.  It was intense and getting worse, and I think my bad habits of cycling in the heat/sun/sweating helped to aggravate it.  I also noticed these "ringworm like" circles that itched terribly and thought I better see a dermatologist.  It wasn't ringworm, but the herald patch from Pityriasis rosea, that frequently precedes the rash.  Apparently it was triggered by the meds and probably also by the heat and sweating.  Apparently its viral and takes about 6+ weeks to cycle through.  It wasn't fun, but once over, didn't come back again.  

Just suggesting as one of the many possibilities that your derma will likely diagnose during your appt.  Hope all goes well.  Following is some more info:

http://dermnetnz.org/viral/pityriasis-rosea.html

[suezeeque]

I am 12 weeks post early EOT.  As stated in my original post, the skin issues worsened at about week 20 of treatment which included interferon (SOC) and continue now.

I don't believe myself to be special.  I think the likelihood is much greater that my health issues are something common, rather than something RARE (dermographic urticaria and vigorous achalasia - I mean, who has ever even HEARD of these things?).

I don't claim to know everything about everything.  All of these problems occurred either at the same time or one right after the other.  They all may be related, they may not be.  

Your experience with psoriasis is not going to be the same as another person's.  With so many different types, how can you say symptom x doesn't match with your understanding?

I dunno, man.  It's all good.  I'll see a dermatologist.

[HectorSF]

My apologies if I upset you. Sorry to have offered my experince with hepatitis C, treatment and psoriasis.  

You are not on treatment now I am confused as to how interferon could be causing your skin rashes now? "This past Thursday, after getting out of the shower, I was covered in small red spots."

Interferon can make psoriasis worse in people with the condition so they need to see a Dermatologist BEFORE starting treatment in-case the interferon causes the psoriasis so become unmanageable during treatment. I was treated for my hepatitis C in 2007 with interferon and ribavirin. I was told I needed to see my dermatologist before starting treatment to be prepared if my psoriasis became unmanageable during treatment.

From the Pegasys package insert:

"5.5 Autoimmune Disorders

Development or exacerbation of autoimmune disorders including myositis, hepatitis, thrombotic thrombocytopenic purpura, idiopathic thrombocytopenic purpura, psoriasis, rheumatoid arthritis, interstitial
nephritis, thyroiditis, and systemic  lupus erythematosus have been reported in patients receiving alpha interferon. PEGASYS should be used with caution in patients with autoimmune disorders. "

Sorry but psoriasis has no relation to the symptoms that you described or the pics you posted. I could go into what psoriasis looks like and where it appears but I don't think that would be helpful for you anyway. Of course there is only one way to know for sure and that is to see a Dermatologist for a diagnosis. They should be able to diagnose and treat you for you rash which does look pretty bad.

Good luck.

Hector

[suezeeque]

There is also no need to be insulting.  

"Unless of course you need to think you have every condition under the sun based on nothing. If your other diagnosises/conclusions about your health are as misconstrued as you speculation about psoriasis is, then I'm afraid who knows what is real and what isn't."

Seriously???

I lived with symptoms that were so bizarre I was asked by each and every doctor I saw if I had any history of mental health issues.  That was until I had an esophogeal motility study.  I mentioned to the doctor who did that test, after it was done, that I had been perceived to be NUTS rather than ILL.  His reponse?  "You can't fake that.  Your contraction numbers were off the charts."

So I'll thank you not to tell me I'm crazy.  Please and thank you.

[suezeeque]

First, Hector, no need to be so angry.

Second, my question was related to INTERFERON and the other medical issues I have.  Whether or not INTERFERON may have exacerbated already existing conditions.

Third, as I'm sure you're aware, there are many different types of psoriasis.  

I had made no attempt to "diagnose myself on the internet".  As stated, I thought what was on my arm/leg appeared to be ringworm.  It is not.  I applied cortisone cream immediately and now it has faded so that I can barely see it.  If it was ringworm, cortisone would do nothing.

I'm uploading some pictures.  

[HectorSF]

Diagnosing yourself on the Internet is always a bad idea. It is like a defendant defending himself in a court of law. You are only going to lose.
Your profile says you live in Toronto. You can't find any competent doctor in the whole city?

Psoriasis/psoriatic arthritis? First psoriasis doesn't look anything like ringworm. Seriously, not even remotely. Second "The hip pain, peeling fingers, esophagus spasms, itching so bad". Not sure what web site you are getting your information from, but these are NOT symptoms of psoriasis. Psoriasis is a autoimmune disease of the skin. Any experienced primary or dermatologist can diagnosis it in about 10 seconds. All they have to do is look at it. It isn't rocket science. How do I know? I had chronic moderate psoriasis for 10-15 years. Still do but my immune system is so weak due to ESLD it is not even an issue anymore.

To make a long story short. Find a doctor to diagnosis your real health issues. Second you should stop trying to diagnose yourself on the Internet. Unless of course you need to think you have every condition under the sun based on nothing. If your other diagnosises/conclusions about your health are as misconstrued as you speculation about psoriasis is, then I'm afraid who knows what is real and what isn't.

Also, and I would think this is obvious but..this forum is for the discussion of hepatitis C. Please post other medical issues on the appropriate forum so that others here with issues with hepatitis C can post their questions, concerns and needs for information about hepatitis C and liver disease.

Good luck!

Hector

[suezeeque]

Yes, I was also referred to an infectious disease specialist in early 2010.  No lyme.

[working dog]

sorry its...lyme

[working dog]

have you been tested for lime?