Advice needed about DMARDs

[Fred]

Jim it makes no difference whatsoever if it's used in Germany or anywhere if it's not used in the UK for psoriatic arthritis. It also makes no difference what you think about increasing the dose, as it's not going to happen. You have to remember that each country has their own protocol when it comes to treatment, we may not like it but they are rules that they have put in place and a doctor has to abide by those rules.

Fumaderm (even though the DMF gang don't like it) is not widely used in the UK and you are not going to change it. You may think it's "pathetic", "it sucks", "the dermatologist is blindfolded", "frustratingly silly" and you may even feel like writing to a German doctor about it. But you live in and are being treated by the NHS.

I say you have to get over it as it's the way it is in your country. It's not available here, so we try other things.

Sorry but I do really think you should forget about going against your doctor as their hands are tied. I would say either put up with it the way it is on Fumaderm (that would be my choice if I were you) or move on to a Bio which will soon sort you out.

Also dump the rheumatologist and just deal with the dermatologist. And stop trying to work a way around their protocol it aint gonna work.  

Fred runs off before getting beaten up by the DMF gang.  

[jiml]

TNFs would be a great option - however I'd be a bit concerned on where the PC fits into equation. The options the rheumatologist gave really aren't options. He is just so using them as a clock block for more expensive treatments.

Thanks Matari that's my thinking as well....it's all about the money not to do with my care is my feeling....but I'm not at a point where the pain is too great ....I was just trying to stave off joint damage early, but if they won't let me I'll have to wait and if I get worse take their advice
Our system is not like yours in the US here we don't choose our doctors we tend to go where we are sent by our GPs and we generally don't have a choice of hospitals

[jiml]

Jim it makes no difference whatsoever if it's used in Germany or anywhere if it's not used in the UK for psoriatic arthritis. It also makes no difference what you think about increasing the dose, as it's not going to happen. You have to remember that each country has their own protocol when it comes to treatment, we may not like it but they are rules that they have put in place and a doctor has to abide by those rules.

Fumaderm (even though the DMF gang don't like it) is not widely used in the UK and you are not going to change it. You may think it's "pathetic", "it sucks", "the dermatologist is blindfolded", "frustratingly silly" and you may even feel like writing to a German doctor about it. But you live in and are being treated by the NHS.

I say you have to get over it as it's the way it is in your country. It's not available here, so we try other things.

Sorry but I do really think you should forget about going against your doctor as their hands are tied. I would say either put up with it the way it is on Fumaderm (that would be my choice if I were you) or move on to a Bio which will soon sort you out.

Also dump the rheumatologist and just deal with the dermatologist. And stop trying to work a way around their protocol it aint gonna work.  

Fred runs off before getting beaten up by the DMF gang.  

Nooo I'm not going to even disagree with you Fred and it looks as if you are right, but I will have one more shot in August at the dermatologist and then I will let it go .....Ive not been offered any biologicals if I had I might go along with it

Don't run off all opinions are welcomed by me  

[Fred]

Don't run off all opinions are welcomed by me  

Good. So get your hair cut too whilst you're listening, that comb-over needs a trim.

[jiml]

Don't run off all opinions are welcomed by me  

Good. So get your hair cut too whilst you're listening, that comb-over needs a trim.  

not that opinion

[mataribot]

Jim,

You might also consider that most people with PsA do not see more than a 20% reduction in symptoms. Switching medications might not give you better results. It is a risk you have to take based on what is going on.

[jiml]

Jim it makes no difference whatsoever if it's used in Germany or anywhere if it's not used in the UK for psoriatic arthritis. It also makes no difference what you think about increasing the dose, as it's not going to happen. You have to remember that each country has their own protocol when it comes to treatment, we may not like it but they are rules that they have put in place and a doctor has to abide by those rules.

Fumaderm (even though the DMF gang don't like it) is not widely used in the UK and you are not going to change it. You may think it's "pathetic", "it sucks", "the dermatologist is blindfolded", "frustratingly silly" and you may even feel like writing to a German doctor about it. But you live in and are being treated by the NHS.

I say you have to get over it as it's the way it is in your country. It's not available here, so we try other things.

Sorry but I do really think you should forget about going against your doctor as their hands are tied. I would say either put up with it the way it is on Fumaderm (that would be my choice if I were you) or move on to a Bio which will soon sort you out.

Also dump the rheumatologist and just deal with the dermatologist. And stop trying to work a way around their protocol it aint gonna work.  

Fred runs off before getting beaten up by the DMF gang.  

Nooo I'm not going to even disagree with you Fred and it looks as if you are right, but I will have one more shot in August at the dermatologist and then I will let it go .....Ive not been offered any biologicals if I had I might go along with it

Don't run off all opinions are welcomed by me  

Thanks Fred and all for suggestions they have all helped me in my discussion

Well yesterday afternoon I went to my  appointment with the Rheumatology nursing practitioner who to be honest spent more time than I deserved with me. She has been in rheumatology for years and is passionate about treatments and we spent a long time discussing the various treatments, she has ruled out biologicals as I have to try salfasulfazine or leflunomide or methotrexate before being considered for biologicals. I learnt a lot from her and have a lot of respect for her and the amount she knew

I explained my position that I had a good drug that works excellently on my psoriasis and that I am reluctant to give it up for fear of my psoriasis returning. I said I was quite prepared to try something but that I was keen to see if Fumaderm at a higher dose could work for me.

I had been to the dermatologist earlier in the week and he wrote to rheumatology saying if they agreed he would up my dose ......as my bloods were good lymphocytes were 1.35 and all other functions were good

She has agreed to go with my suggestion and for me to go and see her again in 3 months and we can assess the arthritis again and if there is no sign of improvement or the scans show further erosion of the joints, I feel I will have no option other than to try leflunomide as she was keen to halt the deterioration

[Fred]

Thanks Fred and all for suggestions  they have all helped me in my discussion  

Well yesterday afternoon I went to my  appointment with the Rheumatology nursing practitioner who to be honest spent more time than I deserved with me. She has been in rheumatology for years and is passionate about treatments and we spent a long time discussing the various treatments, she has ruled out biologicals as I have to try salfasulfazine or leflunomide or methotrexate before being considered for biologicals. I learnt a lot from her and have a lot of respect for her and the amount she knew

I explained my position that I had a good drug that works excellently on my psoriasis and that I am reluctant to give it up for fear of my psoriasis returning. I said I was quite prepared to try something but that I was keen to see if Fumaderm at a higher dose could work for me.

I had been to the dermatologist earlier in the week and he wrote to rheumatology saying if they agreed he would up my dose ......as my bloods were good lymphocytes were 1.35 and all other functions were good

She has agreed to go with my suggestion and for me to go and see her again in 3 months and we can assess the arthritis again and if there is no sign of improvement or the scans show further erosion of the joints, I feel I will have no option other than to try leflunomide as she was keen to halt the deterioration

I can't speak for the others Jim, but you are welcome. Psoriasis Club is all about sharing and support from real people with no ulterior motive, we're all in it together and if our conversations help each other then Psoriasis Club is doing it's job as I intended it it to do.

If it helps, I would still say stick with Fumaderm. Leave the Bio's alone until you really need them (you won't need to ask when that is with psoriatic arthritis as it will strike you down very hard when the time comes) but for now enjoy your life with mild psoriatic arthritis  

[jiml]

Thanks Fred I intend to enjoy myself without changing my drug of choice unless the pain gets intolerable ....although she did warn that it could get aggressive and do real damage and she was keen to halt the damage before it got bad, I have her phone number if I need a quick appointment and she has given me some Cochrane reviews to read
But I'm in no hurry while my pain is mainly in the mornings


I'm off for a drink in the bar now

[Fred]

Thanks Fred I intend to enjoy myself without changing my drug of choice unless the pain gets intolerable ....although she did warn that it could get aggressive and do real damage and she was keen to halt the damage before it got bad, I have her phone number if I need a quick appointment and she has given me some Cochrane reviews to read
But I'm in no hurry while my pain is mainly in the mornings  


I'm off for a drink in the bar now  

I'm picking up the tab in the bar tonight Jim so fill your boots.  

Last serious post from me tonight: Trust me Jim (and anyone else reading this) I would say yes you should be checked for psoriatic arthritis and it should be checked often with all psoriasis patients in my opinion. But I would say (and again this is a personal opinion) even if you do have psoriatic arthritis, hold off for the the more serious treatments (Bio's) as long as you can as like All treatments for psoriasis and psoriatic arthritis they will eventually fail and you will need something else.  

There is no cure for psoriasis and as you know it's all about management, but psoriatic arthritis is a B******d and can/will ruin ones life and it's harder to manage.

Give me flakes of skin all over the place any day over being locked up and unable to move.

Merlot Time, see you in the bar.