If you are a GP, and someone presented with these symptoms....

[overthehillswegoo]

What would you be querying?

Lower back pain for two years, mainly to the right side but can be central (pelvis x-ray came back normal). Hurst when standing still or seated, but fine when moving/exercising.
Pain/stiffness in middle of back when straightening up after bending over.
Nail psoriasis (diagnosed).
Occasional stiff neck, coinciding with headache.
Tingling/numbness in left foot (last 6 month) and sometimes up lower leg. Currently seeing a physio to help, and nerve conductor studies came back fine.
Bunions, and shooting pain in big joint.
Severe dry eye for two years (now being treated by steroid drops from opthalmologist).
Constant sore, flaky ears (previously given drops for 'eczema' in ears)
Red, sore rash on underams.
Red, sore rash around eyes (only really happens in Winter).
Genital itching/soreness.
Recurring sore elbow joint, hurts to rest it on desk whilst working.
Infrequent knee pain.

All of the above are happening now, not at different time periods.

Had brain and spine MRI to rule out MS (referred for this due to eye problems and, at the time, numb hands), both scans came back showing no lesions.

Lots of bloods tests ran for rheumatoid factor, deficiencies etc. All came back ok.

If this was your patient, what would you be thinking next? TIA

I have all this, OP. I have diagnosed psoriasis (plaque and flexural) and psoriatic arthritis, as well as other auto-immune disease.

The NHS is shit at diagnosing psoriatic arthritis because PSORIATIC ARTHRITIS IS SERO-NEGATIVE. Of course the basic blood test they do is negative. Sorry for shouting but it winds me up.

The bummer is that while I'm now on an effective biologic immune-suppressant, the damage caused to my joints over decades has (massively simplifying here) allowed some opportunistic forms of osteoarthritis to creep in. This is because the NHS thresholds for biologic treatment are really high. I was pretty fucked up physically/medically by the time I got it.

I'm hoping for better for a younger generation

Even the NHS website says 1 in 3 people with psoriasis has psoriatic arthritis, so I'd say your chances are pretty high

Wheat/gluten can cause a few of these.
Sugar doesn't help either.
Eliminate both and see how it goes. I find it makes a difference.
Skin soreness and itching can be fungal and sugar makes it worse.

Dry/sore eyes - allergies to perfumes, the crud that is added to everything these days and pollen/dust. Remove all smelly stuff from your home, use fragrance free, check labels for limonene, linalool, geraniol and avoid them, especially stuff like air fresheners and Zoflora which are really bad.There are a couple of others, you may also need to avoid anything citrus scented, and in my case, lavender.
Steroids have side effects, read the details closely before using anything.

If you have hurt yourself in the past you can get flare ups, ie: standing suddenly and pulling a muscle in your back, falling and hurting your leg, twisting an ankle, can be irritated by weather changes.

Flat feet can cause leg problems as can continued wearing of flat footwear. Oddly shaped toes can also be a problem and cause leg pain.

Deficiencies in B vits (not just 12) and D which should be taken with K to prevent calcium deposits, plus minerals, check potassium, magnesium etc.

You are looking for a whole body illness, which it may well be, but the symptoms could be caused by an allergy or allergies or intolerance.
Look at your diet and surroundings before going through lots of tests.

Yes just tell/ask them. Something like “I feel I’m getting nowhere, I’m concerned that there might be something underlying which is being missed such as PA, I think a rheumatologist referral would be good”.

Ive done this twice, once for Dd and once for me. Both times we were diagnosed with Ehler Danlos syndrome, both times I told the gp I thought it was EDS. Prior to my diagnosis Dd had been fobbed off multiple times with anxiety/stress, I’m sure they thought both me and her were hypochondriacs. By the way if someone had asked me if 8 was hypermobile I’d have said no……I thought the stuff I could do was normal and I can’t do the text book bendy fingers thing.

it was an osteopath who told me my lower back and pelvis was hypermobile and he thought I had eds. he was treating me for sacroiliac joint pain. Was like a lightbulb for me and really seeing as Dd was already diagnosed I should have known. You can have EDS and be “stiff”. I feel about 80yo! I’d been seeing a physio for years (well three different ones) but for me it was the osteopath who knew his stuff.

Autoimmune stuff runs through our family like wildfire, coeliac, thyroid issues, fibro. My dad was very ill with an unidentified autoimmune illness, he was actually an inpatient in hospital for six months and bed bound with it for the last few years. He got referred to Addenbrooks and I remember the consultant there said that not all autoimmune illnesses are recognised or have names, that maybe 30 years ago we knew about 20 and now we know of 80 but he reckoned there’s probably hundreds. But yes, rheumatology referral would be good.

Could the pain from the bunions have changed your gait perhaps and contributed to back/pelvic pain? Other thoughts ankyllosing spondylitis? (Non medical speculations)

Do not give up, I was even accused by my family of making up illness. Struggled for a couple of years with high pitched hearing loss generally feeling unwell. Ended up in A&E with chest pain where they picked up I had kidney disease the chest pain was gallstones caused by the CKD. They also picked up sjogrens disease this was partially responsible for my kidney disease, now got Raynards being tested for coeliac joint pain also found out I had a fractured pelvis.they now say Connective tissue disease not ruling out lupus or amyopathic myositis. I had to retire from the NHS. My mobility decreased really quickly as did my social life just starting to get going again this started in 2018. Be aware autoimmune diseases like sjogrens 30% can be seronegative, think the menopause was partly responsible for this developing.

Download the RheumaBuddy app to record your symptoms daily, you’ll be able to show this to a consultant once you get an appointment. I have rheumatoid arthritis and did have tingling in my left foot, it was because I’d unknowingly dislocated a joint in my foot and it was diagnosed after an X-ray, I had surgery on it to shorten the bone.

I'd want a full thyroid panel- even if your levels are slightly out it can cause catastrophic symptoms. I think the pain in lower back sounds like sacroilitis- ankylosing spondilitis is possibility too. Definitely try for referral to rheumatology

I agree with this as a possibility. The 'Normal Range' is quite a long range and I was told often that my B12 was 'normal' when in fact it was at the low end of 'normal'. I gave up on my GP - take high strength B12 which I can buy over the counter. I've done this for years and those sort of problems were sorted. The itches/rashes MIGHT be Diabetes - or a fungal infection.

Fibromyalgia

Psoriatic arthritis/ sero negative arthropathy (not a dr, am a nurse practitioner and have sero neg arthritis)

Optase spray is what got rid of my eyelid excema. I got it on Amazon.

Do you use a good moisturiser like Aveeno/ CeraVe for your skin?

I think the ophthalmologist may have noticed if the OP had blepharitis.

if you think about it you’ve basically got three issues: a dodgy disc - occasionally causing tingling down your neck. Which is very common and symptoms can come and go. Pilates is very good for preventing flare ups.

eczema - causing dry eye, skin issues and itching. Have you tried to identify triggers? Allergy testing?

and bunions - which are a separate problem.

Ankylosing Spondylitis.

Well that's obviously not true.

Totally agree with you after speaking to my doctor yesterday it all makes sense to me now but I didn’t understand how a vaccination can actually set all that off.
I was told over eight years ago I had Lupus. Then after the vaccination I got so ill the doctors gave me so many different courses of antibiotics and nothing worked. Then inflammation just spread everywhere. Even now the muscle that was injected is warm and sore and hurts all the time 2 yrs later. I never thought I’d have this reaction.
Now more and more is been said about peoples reaction to vaccination and it’s far better to have natural immunity. I wish I knew that way back in July 2021 and I definitely wouldn’t have had the vaccine. I’ve asked my son not to have the covid vaccine. He’s always had reactions to vaccinations I remember how ill he was the MMR vaccine and we were told because it’s egg based. My son has allergies to lactose and eggs but we didn’t know that at the time. Plus with him been my son I’d be extremely worried about him ending up like me. My husband also just been diagnosed with inflammatory bowel disease as well his entire bowel is ulcerated. He had three covid vaccinations plus now has arthritis in his feet and ankles. He says he’s never felt healthy since he had the vaccination but weather it’s just a coincidence we really don’t know but they are running so many tests he’s had cameras down his throat and a colonoscopy and now they want him to take a pill that takes pictures all through his GI system and plus more bloods and scans. They are going to doing steroid injections in his feet and ankles to help with pain so he can carry on doing his work, he’s a joiner and worked for same company for over 35+ years but while he’s been Ill with symptoms from inflammation and ulceration of his bowel he’s had to cut his hours down from a 50 hrs to 35 hrs per week and even then he walks through the door and can hardly walk. Every time they give him pain relief it starts him bleeding badly from the bowel, they’ve just started him on Codeine it’s helping his mobility now. He’s hoping to go back to his normal hours soon. We just want to be back to normal and feel healthy again. Ive been told not to give in to the pain and swelling in my joints and how important it is to do resistance training to support my joint’s. So now instead of resting my joints I excuse them to strengthen the muscles that supports my joints.
I actually experimented, I tried resting my hands to reduce swelling but the pain just got worse. So I decided to do some gardening and the pain didn’t get worse which really surprised me. I find the pain is worse when I’m in bed I wake up in agony around 2 am my hands are freezing cold and so tight and swollen. So now no matter how bad the pain I’ll still try to move them they’ve been like this for 12 weeks now. There is no heat just pain and swelling and a fever and the pain is making me feel sick and exhausted. So now I’m looking for ways to deal with this and still do everything I need to do. If anyone has any advice I’d really appreciate it.
ive just ordered some Chinese medicine that is working in reducing inflammation apparently they are using it in China and the US called Nattokinse apparently it’s been used for years to naturally lower blood pressure but they’ve found out it stops the spike protein causing inflammation and stops the damage and these are medical doctors recommended this in the senate. I’ll try anything to gain my health back and fine motor skills back. I’m a artist and this a nightmare for me. I wish you luck and hope you improve and stay fit and healthy. Good luck

This is very true I believed it was all in my head and the doctors were right.

sadly it cost me so much, I knew there was something seriously wrong when I couldn’t feel my baby crowning, so many people told me about the ring of firer. Plus I got upper contractions but no lower contractions. I told the midwife over and over again about numbness in my legs feet and now in in between the legs and bottom I couldn’t feel nothing. Yet I was sent home with my new born, what followed in them eight week was terrible. I told every midwife how much pain I was in and how I had to hold walls for balance because I fell straight back. Non took me seriously and they said I had postnatal depression.
after 8 weeks, I couldn’t use the bathroom and couldn’t walk by this time, my husband believed the doctors and told me to shake myself even though I was still caring for our son. Finally one morning I couldn’t get out of bed. I phoned the gp and told them to help me otherwise I’d call ambulance. The Gp arrived and examined me I was rushed into hospital and they found out I had a condition when your disc’s go central into your spinal cord. They operated but it was too late my spinal cord was crushed and my nerves are dead. My neurosurgeon was so angry how this had happened to me he sat and cried with me. He told me that I’d after catheter and use a bowel evacuation pump and would not have power or feeling in my legs. He told me some people can have regrowth or healing up to 18 months . In that time I kept my muscles strong hoping my body would heal and I refused to use mobility equipment and I dragged myself around hoping that I’d be able to walk again. After 18 months I went back to see my neurosurgeon and nothing had changed. He then told me he knew because he saw the damage but he didn’t want to dash my Enthusiasm for getting my legs walking and standing without help. But I was so gutted.
I knew then that was it.

I was heartbroken because the people I thought had my back and believed in me obviously didn’t. My neurosurgeon advised me to move doctors and take everyone to court. At the time I was just trying to keep my life on track. I was loosing my home because I couldn’t work even though we had mortgage insurance. It took me days to see to myself because I no longer got signals that you get when you need the bathroom I would forget about myself for days. Very dangerous and stupid but my only focus was seeing to my new born who was lactose intolerant so he was sick all the time and in constant pain with his extended tummy and very bad eczema. He needed creaming and wrapping twice a day every day. So everything with me we went out of the window. All his food had to be home made at 8 months to cut lactose out of his diet totally. Then he finally started to improve. It really destroyed many firsts for me, I was sat on entrance to beach because I couldn’t get on and I watched my son through a video camera take his first steps in the sea. I remember tears rolling down my cheek thinking I should be there holding his hands.
honestly not believing in myself cost me so much. Please believe in yourself and never doubt yourself because I never want anyone to end up this way when it’s totally avoidable.
doctors and consultants and every medical worker needs to stop judging and listen and take them seriously. I lost
Never give up fighting I regret it everyday. I lost so much

As someone who is physically fit, exercises strenuously every day … I have bundles of energy

That is super impressive. All those conditions seem to have no impact on OP's ability to move and do stuff and feel energetic. Nor have they caused OP to become overweight. Neither have they caused OP to have to take any medications.

OP was seen recently by an Opthalmologist (this week), a physio, a neurosurgeon, at least one other specialist (?), The GP more than once, had Lots of bloods tests ran for rheumatoid factor, deficiencies etc & 2 MRIs … there’s no way I’m sticking an opinion in. There are a lot of experts involved already.

Full bloods should be taken just to check. Your symptoms could be partly insulin resistance/type 2, partly allergy, potentially hormonal and or PA.

Blood tests will give better idea of future direction. If all normal then referral to look at PA. Id also advise looking at your diet and start to manage overall inflammation.

I'm not a GP but had similar to you and it was type 2, vit deficiencies and allergies. All now managed after 18 maths.

@lljkk you're actually advised to exercise with psoriatic arthritis and ankylosing spondylitis as inactivity makes you feels worse and movement makes you feel better. She's also getting steroid treatment for her eyes and I had no medication either until I had a diagnosis as they can't treat what they don't know you have. I also had several x-rays and MRIs until they worked out that they should be doing an MRI on my SI joint. Immune conditions take forever to get a diagnosis. Average time to diagnose Ankylosing spondylitis is 8.5 years in the UK

I'd be looking at diet. Possibly dairy or gluten intolerances triggering widespread inflammation.

Doesn't explain everything, but some may not be linked.

Not read the full thread but I’ve got psoriatic arthritis and sounds similar to my issues. I also have blepharitis and hypermobility. My bloods have never shown rheumatoid factor or high inflammatory markers. I was lucky one day when I was in rheumatology that a new consultant spotted me in the waiting room and asked if he could test a new scanner on my hands. They were always sore and uncomfortable but cos they weeent hugely swollen and my bloods were ok they didn’t really take much notice. This new scanner picked up inflammation across all my finger joints and damage already to my thumb joint.
Unfortunately you can only rely on yourself to fight your case (as I’ve learnt over the years) so keep pushing if you’re not happy. Don’t just put up with anything if you don’t think it’s right. I hope you get some treatment you’re happy with soon.

My sacroiliac joint showed herniated discs. The itching nurse prescribed a steroid cream for which gave relief. Keep going

Same with iron/ferritin. I was apparently fine, but actually just inside the lines and felt so much better with supplements.

I said I'd come back to update either way.
I was diagnosed with Psoriatic Arthritis last month. Ultrasounds showed inflammation of joints (mild at the minute). I'll be but on Methotrexate shortly.

Nice to have an answer, to know I'm not a hypochondriac, but also a bit crap to know that this is chronic and I'll have it for life. Which I'm sure many PPs on here will have, unfortunately, felt at some point too.
The rheumatologist agreed that many of my symptoms (dry eye, joint pain, nail psoriasis, morning stiffnes, tingling limbs) can all be attributed to this disease.

Thanks for all the helpful input