Essure Device and Arthritis

What you’re looking at here is an x-ray of a left foot in a peri menopausal woman with Psoriatic Arthritis (PsA). The joint I circled has a classic finding we call “pencil and cup deformity.”

Her joint pain and swelling affects her wrist, an elbow, a few fingers and both feet in an asymmetrical fashion.

She was diagnosed with rheumatoid arthritis (RA) two years ago by a rheumatologist. We were both fooled by her labs… She has no rheumatoid factor, but a positive CCP.

CCP is highly specific for RA, but not 100%. If you have symmetrical inflammatory joint involvement, it is difficult to argue what else it could be.

However, the pattern of the joint involvement + this classic pencil/cup deformity is more characteristic of PsA. It does happen in RA, but it is rare. Additionally PsA tends not to have a rheumatoid factor.

What about the +CCP? Labs are like psychics, I believe them if what they are telling me stacks up with the rest of the evidence: history and other objective findings.

Some might be inclined to throw their hands in the air and say something to the effect of “who gives it shit! Screw the minutia! It’s autoimmune disease. Just treat her gut.”

That’s sloppy, cookie-cutter medicine in my view. 

When I first got into this, I asked my main mentor… “Mitch, in all of your years of treating these tough cases of autoimmune disease, you must have come up with some magic plan or go to protocol. Please sir, tell me!

To my disappointment he replied, “Sorry Billy Mitchell. I’ve got nothing for ya. It’s case by case.”

I cried a lot in the beginning and was terrified of sitting down patients. Because I thought doing what I do would be a lot easier. I wish I had a magic wand sometimes and that prednisone did not have so many side effects. It really takes some digging and sometimes we never find out what the perpetuating factor is.

And then trying to do this all while a clock is ticking on someone’s joints, eyes, heart or whatever else. Scary stuff I tell ya!

Okay, end the rant.

The specific diagnosis matters!

It’s true that there may be some overlap in biologic therapy, which in my view this woman sorely needs (these changes happened ~12 months time and are starting in two joints on her other foot). But knowing which specific entity this is gets her the right medication sooner ie IL-17, JAK-STAT or Apremilast vs anti TNFs.

Additionally, knowing the specific diagnosis gives us hints as to what the root cause behind the immune dysregulation may be. 

In her case, not much stands out in the history except that we know diet seems to be a perpetuator and that she had an ESSURE contraceptive device installed in her lady parts.

I’ve been rubbing my chin on this one. This is the third woman I’ve seen with PsA that followed ESSURE implantation.

If you don’t know what the ESSURE is, there is a highlight on my IG profile called “PsA IUDs” you should check out.

Long and hard discussion to have with this sweet lady!

Do you or anyone you know have an ESSURE device implanted? Did it precede the development of arthritis?

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Breaking down rheumatology, rheumatoid arthritis, lupus and more. Information that your doctor should be giving you!
All with a Naturopathic Perspective!