New Treatment

[Fred]

Anyway I wanted to give a warning.
So he will know what he will get. Medication that will make him sick. It's the system, but it will not say the system is good. One should use every opportunity to fight a system that makes you sick. A warned person counts for two.
Of course I state this in my own direct Dutch way.    sorry for that, I'll never learn.

Karaokeking, ask if the dermatologist himself would take the medication. I bet he will not as he too good knows what it Is.

I agree again, I doubt many dermatologist would take it. They don't even know what it's like to live with psoriasis, but we have to remember that most people in the UK anyway will have to go down the Methotrexate road.

You know my feelings on Methotrexate, it's a poison and should never be used for the treatment of psoriasis. But you also know my feelings on one has to accept what is available in the part of the world they live in, Methotrexate will not kill you, yes it is a crap treatment for psoriasis but it will not kill you.

If the creams have failed, then you may not have much option but to try methotrexate before they will offer anything else. It's the way the system works, it's a free system and one has to follow the rules.

If he gets prescribed methotrexate, it may help him (some as you know say it works) but once he has tried it and failed or he cant handle it (hint hint) then that is when they will move on.  

[Caroline]

It will not kill you Fred, but it is quite dangerous.
If you search on google for "methotrexate and PML", you get quite some hits on this combination. Like NO LINKS ALLOWED. It's not the methotrexate that causes the dangerous PML, but it are the effects of the methotrexate that are dangerous,

Just like one has to stop with DMF if your lympho count get too low.

So if you go on MTX, please do keep a very good eye on your blood situation.

[jiml]

Anyway I wanted to give a warning.
So he will know what he will get. Medication that will make him sick. It's the system, but it will not say the system is good. One should use every opportunity to fight a system that makes you sick. A warned person counts for two.
Of course I state this in my own direct Dutch way.    sorry for that, I'll never learn.

Karaokeking, ask if the dermatologist himself would take the medication. I bet he will not as he too good knows what it Is.

It's a very valid warning and nothing wrong with stating it, it's good you told him it's a fact that it's not a good drug

Never apologise for your direct Dutch way, it's fine

[Fred]

It will not kill you Fred, but it is quite dangerous.
If you search on google for "methotrexate and PML", you get quite some hits on this combination. Like NO LINKS ALLOWED. It's not the methotrexate that causes the dangerous PML, but it are the effects of the methotrexate that are dangerous,

Just like one has to stop with DMF if your lympho count get too low.

So if you go on MTX, please do keep a very good eye on your blood situation.

Caroline I don't need to search Google for methotrexate and/or anything, I have my own opinion and know it well enough. But as you know we can all find negatives about other treatments and PML, and what we have to remember is that not all treatments are available to all people.

We may not like a certain type of treatment, but we have to keep in mind of what is available to others in their situation or country they reside in.

Luckily these days they do monitor people on methotrexate in the UK unlike they did with me many years ago, and I'm just suggesting in answer to karaokeking's question on what will probably happen. I may be wrong and that is why I pointed out that none of us are medically trained, we are just people giving opinions. Yours and mine are the same (don't go for methotrexate) but in his situation I can't see another door that will be opened. However once he fails or can not tolerate it then more doors will open Hint Hint Hint.  

Oh and I'm not Dutch, but probably as direct as you. (Or it has been said sometimes more direct than you)  

[Turnedlight]

I thought there was a treatment 'ladder' we all go on in the UK, topical, then uvb, then drugs like methotrexate, then biologicals.

I did take mtx for about two years, it's true to say it did almost clear up my psoriasis and I did not have side effects for most of the first year. But my body must have found a way around it as the p gradually came back, then doses were put up and side effects (muscle weakness and fatigue - I never got the nausea) came in and rapidly became too bad to put up with. If I only had p mildly and it was steady like that I would probably not go on any drugs and just accept it.

Mtx is worth a try but you may not realise it is spoiling your life as its a gradual thing, just don't doggedly put up with it, tell the derm and they will hopefully move you on.

Have you ever tried one of the stronger steroid like betnovate, if you use it for a short course it can be very effective, worked on me up til my late 30's and I haven't got the skin thinning.

[Fred]

I thought there was a treatment 'ladder' we all go on in the UK, topical, then uvb, then drugs like methotrexate, then biologicals.

Correct it's all here: NICE issues new guidance for GPs treating psoriasis

And the bit you are referring to is just over half way down in the Quote which reads:

Quote:

---

first-line therapy describes traditional topical therapies (such as corticosteroids, vitamin D and vitamin D analogues, dithranol and tar preparations). Second-line therapy includes the phototherapies (broad- or narrow-band ultraviolet B light and psoralen plus UVA light [PUVA]) and systemic non-biological agents such as ciclosporin, methotrexate and acitretin. Third-line therapy refers to systemic biological therapies such as the tumour necrosis factor antagonists adalimumab, etanercept and infliximab, and the monoclonal antibody ustekinumab that targets interleukin-12 (IL-12) and IL-23.

[jiml]

I thought there was a treatment 'ladder' we all go on in the UK, topical, then uvb, then drugs like methotrexate, then biologicals.

Correct it's all here: NICE issues new guidance for GPs treating psoriasis

And the bit you are referring to is just over half way down in the Quote which reads:

Quote:

---

first-line therapy describes traditional topical therapies (such as corticosteroids, vitamin D and vitamin D analogues, dithranol and tar preparations). Second-line therapy includes the phototherapies (broad- or narrow-band ultraviolet B light and psoralen plus UVA light [PUVA]) and systemic non-biological agents such as ciclosporin, methotrexate and acitretin. Third-line therapy refers to systemic biological therapies such as the tumour necrosis factor antagonists adalimumab, etanercept and infliximab, and the monoclonal antibody ustekinumab that targets interleukin-12 (IL-12) and IL-23.

And no mention of fumaderm type drugs

[Fred]

I thought there was a treatment 'ladder' we all go on in the UK, topical, then uvb, then drugs like methotrexate, then biologicals.

Correct it's all here: NICE issues new guidance for GPs treating psoriasis

And the bit you are referring to is just over half way down in the Quote which reads:

Quote:

---

first-line therapy describes traditional topical therapies (such as corticosteroids, vitamin D and vitamin D analogues, dithranol and tar preparations). Second-line therapy includes the phototherapies (broad- or narrow-band ultraviolet B light and psoralen plus UVA light [PUVA]) and systemic non-biological agents such as ciclosporin, methotrexate and acitretin. Third-line therapy refers to systemic biological therapies such as the tumour necrosis factor antagonists adalimumab, etanercept and infliximab, and the monoclonal antibody ustekinumab that targets interleukin-12 (IL-12) and IL-23.

And no mention of fumaderm type drugs

No probably do to it's still new in use by the NHS and that post was made in 2012 ............................................ Fred goes off to see if there has been a change ........................................... Nope there is still no mention of using Fumaderm so it must be only in certain parts of the country and only available to some people as it's not yet classified as a "Line" therapy.

[jiml]

I thought there was a treatment 'ladder' we all go on in the UK, topical, then uvb, then drugs like methotrexate, then biologicals.

Correct it's all here: NICE issues new guidance for GPs treating psoriasis

And the bit you are referring to is just over half way down in the Quote which reads:

Quote:

---

first-line therapy describes traditional topical therapies (such as corticosteroids, vitamin D and vitamin D analogues, dithranol and tar preparations). Second-line therapy includes the phototherapies (broad- or narrow-band ultraviolet B light and psoralen plus UVA light [PUVA]) and systemic non-biological agents such as ciclosporin, methotrexate and acitretin. Third-line therapy refers to systemic biological therapies such as the tumour necrosis factor antagonists adalimumab, etanercept and infliximab, and the monoclonal antibody ustekinumab that targets interleukin-12 (IL-12) and IL-23.

And no mention of fumaderm type drugs

No probably do to it's still new in use by the NHS and that post was made in 2012 ............................................ Fred goes off to see if there has been a change ........................................... Nope there is still no mention of using Fumaderm so it must be only in certain parts of the country and only available to some people as it's not yet classified as a "Line" therapy.

Perhaps it's only available to special people

[Fred]

I thought there was a treatment 'ladder' we all go on in the UK, topical, then uvb, then drugs like methotrexate, then biologicals.

Correct it's all here: NICE issues new guidance for GPs treating psoriasis

And the bit you are referring to is just over half way down in the Quote which reads:

Quote:

---

first-line therapy describes traditional topical therapies (such as corticosteroids, vitamin D and vitamin D analogues, dithranol and tar preparations). Second-line therapy includes the phototherapies (broad- or narrow-band ultraviolet B light and psoralen plus UVA light [PUVA]) and systemic non-biological agents such as ciclosporin, methotrexate and acitretin. Third-line therapy refers to systemic biological therapies such as the tumour necrosis factor antagonists adalimumab, etanercept and infliximab, and the monoclonal antibody ustekinumab that targets interleukin-12 (IL-12) and IL-23.

And no mention of fumaderm type drugs

No probably do to it's still new in use by the NHS and that post was made in 2012 ............................................ Fred goes off to see if there has been a change ........................................... Nope there is still no mention of using Fumaderm so it must be only in certain parts of the country and only available to some people as it's not yet classified as a "Line" therapy.

Perhaps it's only available to special people

Yes they are called Guinea Pigs Jim