Can anyone explain why I was sent for a pelvic exam at rheumatology app please

[anyhelpwith]

Had massive pain in my fingers and wrist since I gave birth 7 months ago. Finally got referred to rheumatologist who doesn't think it's RA, luckily. I've explained how my ankles always hurt too like I've been on them all day. Explained about neck pain I get and why I'm on cocodamol for a herniated disc.

He sent me for a pelvic exam to have a closer look at my sacroilliac joint due to ongoing pain in that area (been going on nearly ten years since pregnancy of first child) I'm just confused why the interest in my back if it's clear it's being caused by a herniated disc on my lumbar spine.
Would anyone know ?
He is going to X-ray my ankles and akylese heels too, he said this is because of my family history of psoriasis (I don't have it but my sister is covered head to toe)

Sorry if I sound really stupid but nothing was really explained and I'm now thinking about it and was hoping anyone with experience might be able to help me understand

Thanks

Go back and ask the professionals.

What do you mean by pelvic exam? An ultrasound, X-ray or internal exam?

If you don’t understand please ask the professionals to explain further. We would rather explain it to you than have you agree with what we say without having the understanding.

Psoriatic arthritis or Ankylosing spondylitis

Yep - psoriatic arthritis and ankylosing spondylitis have similar symptoms to rheumatoid and are often overlooked. Your sister having psoriasis is a red flag for these.

My biology is pretty crap but my rheumatologist sent me for an MRI on my back because the treatment would be different depending on how badly impacted the joints in the back were. I have a diagnosis of PsA in any event but it was more a question mark over whether I also had ankylosing spondylitis too.

Thank you. And I'm so sorry not pelvic exam now that would be weird lol I meant a pelvis X-ray!!

Are they checking for things like Ankylosing spondylitis?

I'm not even sure what that is I'll have to google, all I know is it isn't RA but he's checking if something subtle is going on with my fingers as I have no obvious swelling and all bloods keep coming back normal. And he was interested in my back even though I wasn't there about that I just mentioned it

Maybe looking at an immune disease

Inflammation in the sacroiliac joint is something they look at when considering a diagnosis of psoriatic arthritis.

Ah okay, so that makes sense now ! Could you explain more, I mean why is this something they look at ?

Just looked up Ankylosing spondylitis and that fits too! Especially the heel pain, sometimes it feels like ligaments are snapping over my heels !

I’m really tired as been to rheumatology today and taken a Nytol so hope I make sense. It is possible to have arthritis without having had psoriasis and they look at family history .Some people have what they think is dandruff, others a sweat rash and don’t realise it is psoriasis.

Things they look at for psoriatic arthritis is sacroilitis, a genetic marker in the blood, sausage fingers or toes, nail involvement and problem with the Achilles tendon. There isn’t a definitive test so it is hard to diagnose and often it’s by eliminating everything else.

@Seaitoverthere thanks that's really helpful!
I have what the gp has said is hand eczema, and funnily enough my finger joints tend to hurt more when this eczema flares up.
My nan had bad eczema too. She also had RA.

My Achilles heels hurt in the morning mainly, they feel very tight when I first get up and walk about and then it eases off. My ankles ache throughout the day if I don't sit down often enough. They feel like I've done a 12 hour shift.

Nothing is showing up in my bloods though, only a very very slightly raised inflammation marker of 9 lol.

These are the bloods done today so I'm wondering if anything will show on these as some of these the gp didn't do
They don't mean much to me !

It would be unusual for a GP to test for any of those things as they are specialist rheumatology markers. It all certainly suggests that they are looking toward psoriatic arthritis.

Going forward, ask for all copies of any letters sent to your GP by the rheumatologist, make a note of what tests they do and get the results. Knowledge really is power in rheumatology. Ask questions, know what they are planning going forward. If they send you for a test, ask what they are looking for/eliminating and then what the plan will be. Keep a diary of symptoms and what medication you take everyday. It really helps with your appointments. The most successful outcomes for rheumatology patients come when the patient is empowered.

I hope it goes well.

OP your symptons sound very similar to psoriatic arthritis . I've been diagnosed with this and have been put on methotrexate.

I have a dx of PsA. I’ve had psoriasis since I was too and psoriatic arthritis since 14. I’m 64 now. Getting good meds is the key and to be honest if you’re being checked this early the you’re really lucky, most people have to jump through hoops to get a referral. I hope things work out well for you .
💐

Two!

It is good you are getting checked out and your rheumatologist sounds very on the ball, as said above lots of people wait for ages for a diagnosis. I was pointed at these podcasts which I found very informative and they run online sessions which I found very helpful :

https://www.birdbath.org.uk/psoriatic-arthritis

It’s early days for me as was diagnosed last October but I’ve had it for years with hindsight, going back to my second pregnancy. Menopause has flared it up for me which my consultant said is common. One of the questions asked yesterday was how long my morning stiffness lasts.

It is fairly common for nothing to show in bloods and ESR/CRP to be negative or low and that is another reason why it is hard to diagnose and usually done by process of elimination. I used to work in a rheumatology department back in the day doing a research project (RA not PSA) and the drugs have come a long since then and a much greater understanding of what can help in managing it.

I also have psioritic arthritis and I get eczema too, and and I now have osteo in one finger.

One thing I was told by a physio is that problems with feet and ankles can cause you to walk differently and that transfers upwards into your back and causes more problems.

Thanks so much everyone it's all really helpful, I just want to know what's going on as I know it isn't normal. Early 30's not like I should be feeling pain like this everyday.

Recently it's gotten better but I really do think it's because it's warmer. My skin on my hands has even got better haven't had to use any steroid cream for a couple of weeks now.

Really hoping the pelvic X-ray shows something with my back as I don't want the consultant to think it's all in my head, woke up with a very bad back this morning and aching ankle.

I have a torn ligament in my sacroiliac joint and the referred pain from this is crazy. It gets me in my calf constantly. It took ages to get this diagnosed as physio treated it as sciatica initially but the pain didn't travel down my leg, then as a hip problem...Ever since this problem started my fingers and thumbs are regularly numb. It's worth exploring all areas.

Thanks @CornishGem1975 that sounds horrendous !! I get sciatica too but not as often as I used too, it comes and goes.

Really worrying this pelvis X-ray isn't going to show anything wrong and I'll be sent on my way still in pain !

If they say that the x-ray shows nothing wrong, ask them what the next step is to investigate the pain or what treatment they will give for the pain.

Remember that “The X-ray is normal” is not a solution to your problem. It’s only part of the process.

OP have you had any ultra sound scans? I’ve recently been diagnosed with inflammatory arthritis ( presented with pain and swelling in finger joints but also have old hip, knee and back issues). I was extremely lucky that my GP organised full bloods, and X-ray and an USS. All the tests were in normal range except the scan which showed typical changes.

She gave me a shot of steroids which was really for diagnostic purposes ( god it helped) and started on hydroxycholoroquin but that’ll take time to work. It really sucks having multiple joint pains.

I was super lucky in that between seeing my GP and seeing the rheumatologist with all the teat was five weeks.