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Forum Name: Neurology Topics

Question: Chronic neck/shoulder/scapula pain + psoriasis-type lesions


 rare_vitruvius - Fri Nov 06, 2009 1:00 pm

Hello. I have been diagnosed with psoriasis since I was 12-13 years old. Then, in my early twenties, I started feeling chronic, dull neck pain toward the end of the day. The progression was slow, but it started to involve my shoulders and the region around my shoulder blades. The daily pain onset became earlier until the pain was there when I woke up in the morning. I was put on Celebrex, which has made the pain manageable to a certain point. Without Celebrex, I couldn't work. The pain gets worse if I stay still for too long, or if I walk for too long, irrespective of the load I have on my back. In the US, I was diagnosed with psoriatic spondylitis (possible enthesopathy). However, upon returning to Canada, I was told by my new rhumatologist that she cannot continue Remicade treatments, since there are no radiological sign of my disease. X-rays are negative; CT scan of the pelvis is negative; MRI of C-spine are negative. CK levels have always been normal over the years (around 90). No HLA B27 antigen in the blood.

My American rhumatologist had written, "x-rays do suggest spondylitis with calcification of the anterior spinous ligament and evidence of unilateral sacroilitis." None of this was seen by the Canadian radiologists, which leads me to think my American rhumatologist just wanted to enroll me in his clinical study.

Rhumatology has proven a dead-end; I suspect a possible myopathy. I would like the opinion of a neurologist on this board to know if seeing a neurologist in the flesh is warranted. PT hasn't worked and I'm now waiting to see a physiatrist for cortisone infiltrations.
 Dr.M.Aroon kamath - Wed Nov 18, 2009 10:11 am

User avatar Hi,

Diagnosing 'spondyloarthropathies' (of which Psoriatic spondyloarthropathy is one) has been challenging for rheumatologists (and perhaps confounding for others!) .

There have been a number of criteria proposed,for example...
- European spondyloarthropathy study group(ESSG) classification(does not include HLA-B27 as a criterion)
- So-called Amor criteria (include HLA-B27 as a criterion)
- Americal college of rheumatology (ACR) criteria for Reiter's syndrome
- The CASPAR criteria (Classification criteria for Psoriatic Arthritis)
- Modified McGonagle criteria for psoriatic arthritis
- Psoriatic arthritis criteria of Fournié
- Criteria for psoriatic arthritis proposed by Vasey and Espinoza etc, etc!!....

I do not know which criteria were followed by the american rheumatologist and which criteria by the canadian rheumatologist!. I am not sure whether your condition ultimately may turn out to be Psoriatic spondyloarthropathy or ankylosing spondylitis.

However,i think you should not lose heart so soon. It may be wise for you to stick to one Rhematologist and follow up, rather than to change the diagnosis on your own.
Best wishes!

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