… But I figured I probably should not. We will get to that.
Anywise, regular readers should be familiar with the multi-year, still-ongoing saga of my gimpy pinkie finger, but here is the quick recap for people who do not hang on my every word.
Back in December of 2011, I managed to slice open the first interphalangeal joint of my right pinkie finger on the pull-top lid of a can of soup. This resulted in about a dime-sized flap of skin attached on one side, and I cleaned it out as thoroughly as I could at the time, went to see a doctor as soon as I could and he pretty much said, “Yup, that’s what we would have done,” and I went back about my life.
About six months later, the joint started swelling, and its range of motion/strength really started diminishing rapidly. It got to the point where we had it MRI’d in November of 2012, and the tentative diagnosis at the time was a ruptured pulley. Unfortunately, months of physical therapy did not seem to provide any improvement on the situation, so we decided to see a few more doctors and get a few more opinions… which, of course, wildly varied and often contradicted.
After discussing the options with one of the doctors, we decided to go ahead and do an exploratory surgery where the doctor could lay eyes on the pulleys and other mechanisms directly, take biopsies for full cultures, and drain off some of the fluid that was obviously clogging up the joint. However, despite basically flaying my finger open and growing God-knows what in a lab somewhere, the doctor could not find anything mechanically or pathologically wrong with my finger, aside from “swollen”. His final verdict was, and I am more-or-less directly quoting, “You are just going to have to live with it.”
Fast forward to the NRAAM this past April, where I managed to jam my left ring toe (is there a better name for it?) in a door. Within a few days, it was exhibiting the same symptoms as my pinkie, and, predictably, it refused to let go of its swelling; in fact, it gets to the point where simply wearing shoes hurts, and walking for more than a mile is pretty much right out thanks to the pain. On good days, it does not look too bad… on bad days, you have to wonder if it is not having a massive allergic reaction the way it swells up. Alright, this is no longer a one-off thing; this is starting to look rather systemic.
So we go see a general practitioner, who refers us to a rheumatologist, who says, “Well, it could be this, and it could be this, and it could be this… do you have any other symptoms?” It turns out that some small rashes I have had on my head for a while might be relevant, and the rheumatologist sends me over to a dermatologist, who slices off part of one of the rashes and, a few days later, proclaims “psoriasis”.
It turns out that “psoriatic arthritis” is a thing, and the most likely explanation for all of my various symptoms.
Yay! We know what the answer (probably) is! That means we can fix it, right? ….Right? Well… not so much. Just like psoriasis, there is no “cure”, strictly speaking; you can convince both to go into remission, but they will never really be fixed. In reality, the medical community does not know a great deal about psoriasis, up to and including its root causes, so “treatments” are strictly palliative in nature.
The first order of treatments is Non-Steroidal Anti-Inflammatory Drugs like ibuprofen and naproxen sodium, and we tried that for about a month – the swelling was diminished and the pain was controlled, but it was not worth the stomach upset and the symptoms returned rapidly after I came off the horse pills.
So, it is time to move on to the second level of treatments – I get to start chemotherapy*. Now, before people start viscerally reacting to that word, let us clarify a few points. First, “chemotherapy” strictly means, “the treatment of disease by the use of chemical substances, especially the treatment of cancer by cytotoxic and other drugs,” it is just that the latter half of the definition is implemented a lot more often than not these days. Second, my doctor is recommending methotrexate, which, amusingly, meets both aspects of the definition depending on doses. At high levels, it is quite handy at beating back a number of various cancers, but at lower levels (like 1/10th the dose, if not even less, taken much less frequently), it is a treatment for a variety of autoimmune diseases, including rheumatoid arthritis and, of course, psoriatic arthritis.
At the smaller doses, methotrexate functions as a Disease Modifying Anti-Rheumatic Drug, and is strictly an immunosuppressive – basically it controls the body’s desire to produce more skin cells (the symptomatic rashes of psoriasis are due to out-of-control skin growth, basically) while simultaneously diminishing the inflammatory response at the joints. Honestly, I do not really understand the “how” of this – it involves T-cells and purine metabolism and methyltransferase activity and other things I barely comprehend – but somewhere around 50 years of use indicates it does work, at least for most people treated with it. Plus, it reduces the inflammation in such a way to prevent future damage to the joints by way of continual erosion, which, considering I developed this at the ripe old age of 29, seems like a good thing to me.
It is important to note that this is not a radiological drug, so no “glow in the dark” jokes, please. Still, my parents were mildly amused at their son starting chemotherapy so soon after my father wrapped up his. Situational humor… what are you going to do?
Compared to what some people are going through, I guess I should not complain too much, but this was not exactly the answer we were expecting. Still, we have an answer, and a path forward, so I guess there is that.
And on a related note, if you ever need any rheumatology work done in the Greater Raleigh-Durham area, we strongly recommend looking up Dr. Tony Ning at Triangle Orthopaedic Associates.
(* – This is what I really wanted to title this post, but I figured the explanation was really necessary, for honesty’s sake.)
(Note: I am not a doctor and I am not your doctor. A lot of what I am saying may be wrong; take this all with a grain of salt.)