Fumaderm and kidney problems

[Bill]

Severe psoriasis. Comorbidities. No problem-free options. Limited treatment expenditure. Substantial testing and consultation with the patient. A health system where DMF is available. Yes, I get the impression of an excellent standard of care. Alarm bells would be ringing for me were funds being weed up a wall on multi-directional spray cans.

[mataribot]

Stelara has been studied for elderly patients. It's less immunosuppressive than most drugs on market. I have no problems with DMF as the first systematic choice, but Cyclosporine should be banned from use for psoriasis.

[Caroline]

I only can say that cyclosporine would never be my choice as a treatment.

[krug22]

Thanks for your comments! Dermo had huge personality clash with Eric who is rather deaf - Dermo speaks quietly and is Russian but since we have been seeing him at the local hospital I have been going with him. Dermo is ok if challenged and will explain - he asked me to go to the BAD website and there is a huge amount of information there. He also said they tried the topical treatments first because the more advanced treatments often had side affects so I was warned. Very hard to make decisions for Eric frankly but I am not sure how much he understands and he just does not like the Dermo which leaves it up to me to try and negotiate a way forward! Also Eric literally could not walk this time last year - his ankles and calves were horrific with the sores and we had bleeding and constant risk of infection so Dermo had to do something. I think I knew there would be no 'quick fix'. Eric was against the injections but may have to re consider now.  

Also please remember Eric has Lupus (which is dormant at the moment)/Gout, Acid Reflux and Aneamia so yes there are considerable co-morbidities going on. Light therapy was not an option due to the possibility of it triggering the Lupus. So there are no easy options.

At the moment, Eric is complaining of itching so it is going to be a difficult weekend... I just really hope we do not have a  major flare up. I have left a message with the nurse and hopefully will get a call from Dermo on Tuesday. One option might be to put Eric on a much lower dose of Fumaderm until the dermo can see him but I do not know what the latest kidney function test taken on Tuesday shows......

[Caroline]

Hi Krug,

At first I must say I feel really sorry for Eric. That he has to go through all this on his age. And too bad of his inconvenient communication with the Derm.

Reducing Fumaderm is always possible, but I don't have a clue what influence it will have on the kidney problem. The fact is that Fumaderm is an excellent treatment certainly if Eric could cope with it. Anyway it could be discussed with the derm.

I looked at the BAD website. No mention of DMF on that, which is weird as over here in the Netherlands it has become a more and more used treatment.

Difficult to give an advice for Eric.

I wish you strength with him, and we are always here to talk to and perhaps come up with ideas.
Caroline

[krug22]

Hi Krug,

At first I must say I feel really sorry for Eric. That he has to go through all this on his age. And too bad of his inconvenient communication with the Derm.

Reducing Fumaderm is always possible, but I don't have a clue what influence it will have on the kidney problem. The fact is that Fumaderm is an excellent treatment certainly if Eric could cope with it. Anyway it could be discussed with the derm.

I looked at the BAD website. No mention of DMF on that, which is weird as over here in the Netherlands it has become a more and more used treatment.

Difficult to give an advice for Eric.

I wish you strength with him, and we are always here to talk to and perhaps come up with ideas.
Caroline

[krug22]

Thanks Caroline - do appreciate your comments. I think frankly when Dermo asked what we wanted to do, I sort realised it was going to be a loss/gain analysis rather than a black and white answer.

 I will discuss reducing the Fumaderm as an option when I get to speak to the dermo - just hope he has not had a flare up in the meantime. I do realise that some of these drugs can be quite toxic on the elderly but until the cyclosporine and the fumaderm he literally could not walk - the pain in his feet was so bad, and it does come down to quality of life. I do find it hard to make decisions for my much older husband when I have no medical knowledge.  I guess I wait now and hopefully the dermo should have latest kidney tests results when he phones and we can navigate way forward. The Lupus does complicate things as it does limit some of the treatment options.

[Caroline]

Recently I am using something else additional for my PSA., it is called PEA pure, it is a natural painkiller and it reduces inflammation. It does not have the disadvantages of things like paracetamol, that do some harm in your stomach. I am doing quite well on it.
Still it can be very personal if it works I think. When my friend needed a painkiller because of he had hurt his ankle, he took it and got a nausea from it. Bit of a pussy,

[jiml]

Thanks Caroline - do appreciate your comments. I think frankly when Dermo asked what we wanted to do, I sort realised it was going to be a loss/gain analysis rather than a black and white answer.

 I will discuss reducing the Fumaderm as an option when I get to speak to the dermo - just hope he has not had a flare up in the meantime. I do realise that some of these drugs can be quite toxic on the elderly but until the cyclosporine and the fumaderm he literally could not walk - the pain in his feet was so bad, and it does come down to quality of life. I do find it hard to make decisions for my much older husband when I have no medical knowledge.  I guess I wait now and hopefully the dermo should have latest kidney tests results when he phones and we can navigate way forward. The Lupus does complicate things as it does limit some of the treatment options.

Hi krug personally with his kidney condition and his psoriasis fairly well controlled. I would reduce by at least 1 tablet and see how it goes. I would never advise on increasing but in view of his kidney problem he should stop the fumaderm, but I can understand your reluctance... So in the meantime try dropping the dose by one tablet

[krug22]

[quote pid='75458' dateline='1458376974']
Thanks Caroline - do appreciate your comments. I think frankly when Dermo asked what we wanted to do, I sort realised it was going to be a loss/gain analysis rather than a black and white answer.

 I will discuss reducing the Fumaderm as an option when I get to speak to the dermo - just hope he has not had a flare up in the meantime. I do realise that some of these drugs can be quite toxic on the elderly but until the cyclosporine and the fumaderm he literally could not walk - the pain in his feet was so bad, and it does come down to quality of life. I do find it hard to make decisions for my much older husband when I have no medical knowledge.  I guess I wait now and hopefully the dermo should have latest kidney tests results when he phones and we can navigate way forward. The Lupus does complicate things as it does limit some of the treatment options.

Hi krug personally with his kidney condition and his psoriasis fairly well controlled. I would reduce by at least 1 tablet and see how it goes. I would never advise on increasing but in view of his kidney problem he should stop the fumaderm, but I can understand your reluctance... So in the meantime try dropping the dose by one tablet
[/quote]