I am currently taking Methotrexate (MTX) and its shortcomings are well documented. Having to take bloods regularly, reducing alcohol intake etc etc. Fortunately I have not had any side effects apart from perhaps being slightly more susceptible to catching a cold and struggling to shake it off. Currently struggling to get rid of a cough after a chest infection.

The reason I believe MTX is the drug of choice for starting with psoriasis sufferers is that it is cheap and generally effective. I believe there are several drugs that could be used for the first round with differing degrees of effectiveness. I recal three but can't remember the names but MTX was said to work 80% of the time with the next closest only 50% effective.

I am aware of other drugs like humira, stelara, fumaderm etc but how do they all fit into the cost benefit model and which have the easiest administration and least side effects. Obviously there may be some very expensive drug with no side effects that you only take once a month but you would be unlikely to get that prescribed as a first choice.

Ideally I think a list of treatments, pros and cons, cost might be helpful. Obviously different treatments may cause different side effects in different people but from and ease of use I am thinking which has least impact on lifestyle, ie allows you to drink and not require blood tests etc.

Hello all,


I'm new to this 'sharing my Psoriasis pains with the world' concept, so please bare with me.

I'm a 39 year old retired Firefighter that was only diagnosed with Plaque Psoriasis after being burned in a structure fire in 2002. I also have Lupus Nephritis.  
It has been one of the biggest challenges of my life. Today, I have roughly 80% of my body covered, not so flaky, but red.
I have tried Embrel and Otezla without success. I am currently undergoing UVB light treatment once a week. This coming week I will begin using Cosentyx. 
Based on some of the responses within the group, I am feeling more confident about this treatment.

I will post my experiences as I progress with the treatment.

Thank you all.

Ric

Hi everyone, 

new to the site so first of all just wanted to introduce myself. 

I am 30 and have suffered with severe psoriasis for about 16 years now... I've pretty much got it everywhere.
Up until a couple of years ago i had managed to control it with light treatment after spending a small fortune on a aramid B (i think) sunbed, unfortunately the treatment slowly stopped working and now doesnt work at all. 

Since my psoriasis came back it has affected everything i do, can't sleep, can't shower at work, can't play football anymore because of the pain, its awful, its basically ruining my life at the moment. My doctor has been prescribing me all sorts of steroid ointments and creams that have been having no affect whatsoever..... I'm running out of patience, i want to try something stronger and have been reading about biologics and systemic treatments but my doctor for some reason seems reluctant to prescribe me anything.

So the reason I've signed up is to find out if anyone has had any joy getting any of these kind of treatments through private healthcare??? I am insured through work with axa private healthcare and am contemplating giving it a go..... i can't take anymore ruined clothes/bedsheets from the ointments anymore with 0 results!!

Anyway... any shared experiences would be much appreciated 

Cheers

Jamie

That's very interesting and a bit disturbing, but not surprising, thank you for posting that, it will give users something to ponder  

Now don't get too excited. This is not one of my short stories.
In a serious vein, I've been thinking about the future. Whilst I'm not in a position yet to start thinking about dating (much too early after the break up) I do realise that one day I will be.
But the thought of attempting a new relationship whilst managing psoriasis seems like an insurmountable obstacle.
My relapses, inability to work and general appearance are going to seriously limit my eligibility. Or am I making mountains out of molehills here?
Anyone got any experiences/ advice to share?

This study set out to analyse serum total IgE levels in addition to the presence and distribution of IgE and FcεRI in psoriatic lesions, and to investigate alteration of IgE and FcεRI after successful systemic treatment.

Quote:

---

Background:
Although elevated serum IgE levels have been reported in psoriasis, the role of IgE in psoriasis still needs to be clarified.

Objectives:
To analyse serum total IgE levels in addition to the presence and distribution of IgE and FcεRI in psoriatic lesions, and to investigate alteration of IgE and FcεRI after successful systemic treatment.

Methods:
Total serum IgE levels were determined using enzyme-linked immunosorbent assay. The expression and localization of IgE and FcεRI was investigated using immunohistochemistry and double immunofluorescence.

Results:
Elevated total serum IgE levels were found in 39% of patients with psoriasis. The levels of total serum IgE were significantly higher in male patients compared with female patients. Furthermore, total serum IgE levels decreased after successful systemic treatment. A positive correlation between IgE+ and FcεRI+ cells and a significant increase of these cells was found in psoriatic lesions when compared with normal skin. Interestingly, IgE+ and FcεRI+ cells decreased significantly after successful therapy with ustekinumab. IgE and FcεRI were coexpressed on mast cells, epidermal Langerhans cells, dermal dendritic cells, macrophages and a small number of neutrophils.

Conclusions:
IgE might participate in the development of psoriasis by activating FcεRI-bearing cells.

Hi I am new to this! 
I've suffered with pustular psoriasis on my hands and feet for nearly 3 yrs now. I've tried every cream, light therapy but still no relief so I was put on Methotrexate which gave me horrendous side effects which is why I was given Humira which I've been on for about 4 wks so far. In that 4 wk period my psoriasis has gone from almost clear to out of control and spreading everywhere else so I have had to start taking the methotrexate again along side it in the hope it stops it spreading further. Back to square one. I have tried a few natural products and detox which I think helped in the past so will be trying that again.
I'm still new to psoriasis and how it can affect you, would really appreciate any advice especially from someone with pustular psoriasis, comments appreciated.
Sam

I would never have said that I was the brainiest person, but PHEW, trying to get onto this forum is a job of its own.

Hello Folks, Just wanted to say hi, this is the first time I have come across a psoriasis forum, really pleased.

This study looked at bone erosion in patients with psoriatic arthritis.

Quote:

---

Objective:
Psoriatic arthritis (PsA) has been recognized as a severe erosive disease. However, some patients do not develop erosions. We aimed to determine the prevalence, characteristics, and predictors of erosion-free patients (EFP) as compared with erosion-present patients (EPP) among patients with PsA followed prospectively.

Methods:
This is a retrospective analysis conducted on patients from the Toronto PsA cohort. Patients with at least 10 years of followup and radiographs were analyzed. Radiographs were scored with the modified Steinbrocker method. Baseline (first visit to clinic) characteristics were used to predict the development of erosions with logistic regression models. To examine the effect of time-varying covariates, Cox regression models were fit for the time to development of erosions from baseline.

Results:
Among 290 patients, 12.4% were EFP and 87.6% were EPP over the study period. The mean time to development of erosion in the EPP over the course of followup was 6.8 ± 6.1 years. EFP were diagnosed with psoriasis at a younger age compared with EPP. In both models, actively inflamed joints and clinically damaged joints were predictive of the development of erosion, whereas a longer duration of psoriasis at baseline decreased the odds of developing erosion. EPP had a higher percentage of unemployment as compared with EFP at baseline and followup visits.

Conclusion:
Among patients with PsA followed for at least 10 years, 12.4% never develop erosions. The clinical and radiographic findings can ultimately assist in the stratification of a patient’s prognosis regarding the development of erosions.

This Danish cohort study looked at the risk of Abdominal aortic aneurysm (AAA) in psoriasis patients and suggests that further investigations are needed.

Quote:

---

Objective:
Abdominal aortic aneurysm (AAA) is a complex multifactorial disease associated with a high morbidity and mortality. Increased inflammation including T-helper 17 cell–mediated effects has been implicated in AAA pathogenesis. Psoriasis is considered to be a T-helper 17-driven chronic inflammatory disease and in view of potentially overlapping inflammatory mechanisms, we investigated the risk of AAA in patients with psoriasis in a nationwide cohort.

Approach and Results:
The study comprised all Danish residents aged ≥18 years followed up from January 1, 1997, until diagnosis of AAA, December 31, 2011, migration or death. Information on comorbidity, concomitant medication, and socioeconomic status was identified by individual-level linkage of administrative registers. Incidence rates for AAA were calculated and incidence rate ratios adjusted for age, sex, comorbidity, medications, socioeconomic status, and smoking were estimated in Poisson regression models. A total of 5 495  203 subjects were eligible for analysis. During the study period, we identified 59 423 patients with mild psoriasis and 11 566 patients with severe psoriasis. The overall incidence rates of AAA were 3.72, 7.30, and 9.87 per 10 000 person-years for the reference population (23 696 cases), mild psoriasis (240 cases), and severe psoriasis (50 cases), respectively. The corresponding adjusted incidence rate ratios for AAA were increased in patients with psoriasis with incidence rate ratios of 1.20 (95% confidence interval, 1.03–1.39) and 1.67 (confidence interval, 1.21–2.32) for subjects with mild and severe disease, respectively.

Conclusions:
In a nationwide cohort, psoriasis was associated with a disease severity-dependent increased risk of AAA. The mechanisms and consequences of this novel finding require further investigation.

Hello all,

I have severe PsO on my knees, back and elbow. I'm looking for natural treatments. Can someone advise me?

Regards,

Mike

This is a small abstract from an early view of a discussion that suggests Oestrogen could be a potential therapeutic option for psoriasis.

Quote:

---

Abstract:

Majority of female patients show improvement of psoriasis during pregnancy. This is demonstrated to be correlated with high levels of oestrogen.

Even in male patient, oestrogen level is inversely correlated with the severity of psoriasis. However, a minority of female psoriatic patients still experience worsening during pregnancy.

Oestrogen might improve psoriasis by suppressing the T-cell immune response, reducing the keratinocyte (KC) cytokine and chemokine production, restoring the balance of redox and enhancing the skin barrier. However, it might worsen the disease by stimulating KC proliferation and promoting angiogenesis.

This complex role of oestrogen in the pathogenesis of psoriasis might explain why the two opposite effects of pregnancy coexist. Data shows that the number of improving patients with psoriasis in pregnancy is double the number of the worsening patients, suggesting that oestrogen may be potentially useful in the treatment of psoriasis.

However, oestrogen is not considered suitable as a long-term treatment subject to negative side-effects. This review discusses current studies on taking selective oestrogen receptor mediators as a novel potential therapeutic option for psoriasis.

Hello everyone! My name is Shane and I am new to this forum. 

I am actually very happy to have found this website, reading through many posts (being the huge researcher that I am), it seems a comforting place when psoriasis can be quite a physiological condition. 

I first had Guttate back in 2012, and it did what it does - appears, stops you from going out much, gets you down, then disappears. However, in about October last year, I started having a couple of patches of dry red skin, then more and more. I was origionally diagnosed with Pityriasis Rosea, another temporary condition. However, after it lasting longer than a few weeks, I paid to see a dermatologist. He diagnosed me with plaque psoriasis. He then told me to google "BAD psoriasis methotrexate" and click on the first link. I am going back to him on May 4th, for blood tests and to start treatment. However, after reading on different websites including this one, it has made me very wary about MTX and I have more questions than answers I can find, so, I would really appreciate some help and advice. 

I am going on two holidays, one with the girlfriend May 17th and one with a group of friends June 24th, these are my main concerns to get it to at least stop looking so angry. I am currently using coal tar, salt baths and moisturiser as this helped with the Guttate. 

•The doctor told me I can drink small amounts of alcohol only. Is this because of it affecting the liver, or low tolerance levels or both?

•How long do they start to take affect?

•Due to being 27, kids are a future thought, what affect have people had stopping after a decent period of time on MTX?  

•I seem to have found more negative stories than good. Can anyone actually recommend MTX or should I push for something else?

As I said earlier, I would really appreciate the help, I want to have a clear plan in my head when I go back to see the doctor in 3 weeks time. Thank you!

This study was To evaluate the efficacy of clazakizumab an interleukin (IL)-6 blocker in patients with psoriatic arthritis.

Quote:

---

Objective:
To evaluate the efficacy of clazakizumab, a monoclonal antibody with high affinity and specificity for the interleukin (IL)-6 cytokine, in psoriatic arthritis (PsA).

Methods:
In this randomized, double-blind, placebo-controlled, dose-ranging study (NCT01490450), patients with active PsA and an inadequate response to non-steroidal anti-inflammatory drugs were randomized (1:1:1:1) to subcutaneous placebo or clazakizumab 25 mg, 100 mg, or 200 mg every 4 weeks, ± methotrexate. The primary endpoint was American College of Rheumatology (ACR) 20 response rate at week 16, with secondary efficacy endpoints at weeks 16 and 24.

Results:
A total of 165 patients were randomized. At week 16, ACR20 response was significantly higher with clazakizumab 100 mg versus placebo (52.4% vs 29.3%; P=0.039). ACR20 responses at week 16 were 46.3% with clazakizumab 25 mg (P=0.101 vs placebo) and 39.0% with clazakizumab 200 mg (P=0.178 vs placebo). ACR50/ACR70 response rates were numerically higher with clazakizumab versus placebo at weeks 16 and 24. Compared with placebo, clazakizumab treatment significantly improved musculoskeletal manifestations (joint signs and symptoms, enthesitis, and dactylitis), with minimal improvements in skin, without clear evidence of a dose response. Clazakizumab was well tolerated.

Conclusions:
This is the first clinical trial of an IL-6-targeted therapy in PsA. Clazakizumab may be an effective treatment option for musculoskeletal aspects of PsA, but further studies are required to confirm the appropriate dose due to the lack of dose response in this study. The safety profile was consistent with the pharmacology of IL-6 blockade and prior clinical experience with this antibody in rheumatoid arthritis.

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I have my little purple booklet and now my consultant tells me that my booklet should go everywhere with me incase I have an accident then medical professionals can know that I have a potentially compromised immune system.

First thing is, do I need to take it everywhere?

How "compromised" is my immune system?

This thread was going to be titled whats purple and in my pants and goes everywhere with me but!

So this is my first thread. I started it in pingu's "Starting MTX" and now I'm moving it here:

Hi guys,

First of all, a BIG thanks to pingu for this user guide, I just finished reading it 

I started mtx last Thursday, 15 mg/week (5 mg/2 pills every 8 hours). On Friday I felt like a zombie, I had a terrible headache, and I threw up several times. Now, everything is good, and I look forward for the next Thursday. Tomorrow I will have my first set of blood tests 
I am covered with P about 3-4%, I hope to see big improvements soon. 
I will keep you updated.

M

I'm posting this thread here, I hope I have it in the right place. If not, please let me know.

For anyone who has read my journal, you'll know I was recently diagnosed with IGA nephropathy. (For those who don't know what this is, it's basically a build up of protein on my kidneys that could possibly affect their function down the line)

While talking to the nephrologist, he mentioned that there was link between psoriasis and IGA N, that psoriasis can trigger protein changes in the urine. Has anyone else ever heard of this? Is there anyone else who has had protein abnormalities in their urine samples?

I would like to say firstly that this is my personal experience and may or may not be indicative of other peoples experiences.

I have had psoriasis for about 35 to 40 years I am now 49 so most of my life. Admittedly in that time the treatments and the efficacy of those treatments has changed. However I want to comment on how to deal with your GP and or consultant.

When I first got psoriasis I was referred to a consultant and went through many different creams. My parents had psoriasis so it was not new but as a child really difficult.

I went through all sort of creams but was never prescribed UVA treatment.

When we discovered a cream that was reasonably effective I was left on that for a very many years. Basically I was a statistic now. A psoriasis sufferer. A sufferer of a chronic illness without a cure. Simply a cost. I received repeat prescriptions at the drop of a hat. At the end of the day I was a patient on my GPs register and he kept me "reasonably content" with repeat prescriptions.

This was not one GP but several as you can imagine in 35 years I moved a few times and every single one was the same. register get a prescription and never see them with reference to my psoriasis again

I discovered sunlight helped so sometimes went on sunbeds and whenever we had sun got some respite there. I was alone. There was no help. OK there were secret remedies guaranteed to cure me on the internet and special diets of knitted oats cooked with the tears of baby unicorns sprinkled with moon dust but they were expensive and dare I say probably not worth it.

In all that time my GP was quite content to have me on steroid creams long term, never calling me in for a consult to see how it was going, offering other therapies or a referral.

It was only when I investigated a little as my psoriasis was getting a little worse and I discovered many new treatments were available.

Now here is the point.

Do not take what your GP or consultant say as gospel, at the end of the day YOU are a CUSTOMER and deserve certain things. Make sure they understand you and your expectations and understand if they are firstly realistic and secondly achievable.

NO that does not mean you always get your own way but certainly I discovered my GP actually knew very little about what was available and I had to request a referral. So first thing is get your referral. Then work with your consultant. You have a lifestyle so some treatments may not be right for you. Some may disagree with you. You also need to give the treatment time.

Bare in mind that this is cost driven, the NHS is a business and somewhere someone has to pay even if its through insurance. If you were paying for your own therapy you wouldn't necessarily go out and get the most expensive when something at a tenth of the cost was effective. Well certainly that's how the NHS works, it works well most of the time. To a degree I feel it is keep the masses at bay with lotions and creams at their GPs. Its only when you ask that you get something a little better. Knowing WHAT to ask is also key.

Educate yourself but be reasonable. You can't expect to go on the very latest high cost treatments if you have not tried the lower cost alternatives. Stick to your guns about getting the right treatment that works for you and your lifestyle, educate yourself and ask questions of your consultant and in here.

It's your life and your skin, work with your consultant. I certainly have been treated a lot better following the little knowledge I have gained through more research. After 4 weeks on MTX I was pretty clear. I was delighted but felt I was a little cheated as I could have been offered the treatment sooner. I had to aks for it though because I would still be on repeat prescriptions if I hadn't.

Hi, I have had PsA for a few years now, and have progressed through a number of treatments such as Mtx (oral and injection), sulfalazine, Enbrel, symponi and now Stelera. I have had bad reactions to these, and I seem to be allergic to most of them.

Over the last 6 months I have developed painful eyes, with eye lids which are swollen, lack of peripheral vision and sensitivity to light.

I have seen an ophthalmologist who has says I either have iritis or euvitis. I have had an MRI today on my eyes, and will see the specialist again soon..

When I saw the ophthalmologist he informed me that a number of people with auto immune diseases, including PsA are prone to these problems.

I was wondering if any other forum members have had similar problems, and how the symptoms have progressed.

Paul