Advice needed about DMARDs

[jiml]

Today I have been to the hospital to see the rheumatologist we had a frank discussion and I informed her again that I was reluctant to come off my psoriasis drug ( Fumaderm ) as it works so well . I'm on 4x 120mg tablets a day

But have noticed joint pain recently and have been diagnosed with psoriatic arthritis, the hospital are passing me between dermatology and rheumatology

The rheumatologist wanted me back on methotrexate but I have refused that.

I asked about Cosentyx and Otezla and was told to suggest something she could prescribe ....I mentioned Humira but I haven't got three swollen joints and haven't failed enough oral treatments to get them

Now I'll get to the point I have also been offered leflunomide or Sulfasalazine ....now as I've never been on a DMARD I have no experience of what to expect, and I'm hoping for some guidance here

[Fred]

#1 Your dermatologist can prescribe Cosentyx.

#2 What about Enbrel.

Here the only one my rheumatologist can prescribe is Simponi (golimumab) but I don't know of anyone using it.

As for Leflunomide or Sulfasalazine I can't help as I've never used them, hopefully others will know more.

Welcome to the psoriatic arthritis club by the way.

[jiml]

#1 Your dermatologist can prescribe Cosentyx.

#2 What about Enbrel.

Here the only one my rheumatologist can prescribe is Simponi (golimumab) but I don't know of anyone using it.

As for Leflunomide or Sulfasalazine I can't help as I've never used them, hopefully others will know more.

Welcome to the psoriatic arthritis club by the way.  

Thanks Fred glad so now I'm in the psoriatic arthritis club ... Not sure I wanted to join that club  

I will speak to the dermatologist next month and discuss coming off Fumaderm in favour of Cosentyx ...but I doubt he will prescribe it ( that's if I don't get one of his underlings) who will do nothing

The rheumatologist wanted me on DMARDs and told me she wouldn't give biological drugs until I had failed on more ( cheaper options) and got more than 3 swollen joints ....apparently I have it but not bad enough to be considered
I am waiting for an appointment to see the rheumatology nurse now as I think the rheumatologist was annoyed that I wouldn't even consider methotrexate ( having given up on it before)

[JohnB]

#1 Your dermatologist can prescribe Cosentyx.

#2 What about Enbrel.

Here the only one my rheumatologist can prescribe is Simponi (golimumab) but I don't know of anyone using it.

As for Leflunomide or Sulfasalazine I can't help as I've never used them, hopefully others will know more.

Welcome to the psoriatic arthritis club by the way.  

Thanks Fred glad so now I'm in the psoriatic arthritis club ... Not sure I wanted to join that club  

I will speak to the dermatologist next month and discuss coming off Fumaderm in favour of Cosentyx ...but I doubt he will prescribe it ( that's if I don't get one of his underlings) who will do nothing

The rheumatologist wanted me on DMARDs and told me she wouldn't give biological drugs until I had failed on more ( cheaper options) and got more than 3 swollen joints ....apparently I have it but not bad enough to be considered
I am waiting for an appointment to see the rheumatology nurse now as I think the rheumatologist was annoyed that I wouldn't even consider methotrexate ( having given up on it before)

Sorry to hear this Jim. I have to express my ignorance I've never even heard of those two drugs. Hopefully there is someone out there with experience to inform us all. Can't blame you with the Methotrexate thing if you couldn't get on with it then you aren't likely to now. Isn't the rheumatology dose is a little greater than the Ps dose? Would it be as well as the Fumaderm, or instead of?

[Fred]

Thanks Fred glad so now I'm in the psoriatic arthritis club ... Not sure I wanted to join that club  

I will speak to the dermatologist next month and discuss coming off Fumaderm in favour of Cosentyx ...but I doubt he will prescribe it ( that's if I don't get one of his underlings) who will do nothing

The rheumatologist wanted me on DMARDs and told me she wouldn't give biological drugs until I had failed on more ( cheaper options) and got more than 3 swollen joints ....apparently I have it but not bad enough to be considered
I am waiting for an appointment to see the rheumatology nurse now as I think the rheumatologist was annoyed that I wouldn't even consider methotrexate ( having given up on it before)

No it's not the best of clubs to be a member of. But at least you got it in later life, and for the moment it's mild and can remain that way too.

I stopped seeing my rheumatologist because she said methotrexate or nothing she wouldn't give me Simponi because it's a tnf and I had to many problems with them) I would just stick to your dermatologist. But that's just my opinion as I think they have more to offer for psoriatic arthritis.

Put it to your dermatologist that you have tried methotrexate and fumaderm and now you have a diagnoses for psoriatic arthritis you want to try a bio before it gets any worse.

I found working with just dermatology easier than trying to work with the two, and most modern treatments help both psoriasis and psoriatic arthritis.

EDIT: Just a thought. As it's mild why not ask for Stelara it is prescribed for psoriatic arthritis too. Some say it doesn't work and I agree it's not as good as the others, but if it gets me from locked up to moving then I'm sure it will help you.

[jiml]

@john thanks for your thoughts .....I think the DMARDs are as well as the current drug as they do nothing for psoriasis. They are Disease Modifying ANtirheumatic Drugs designed I suspect to target the pain of the disease ..but to be honest I don't know

@ Fred I think I will mention Stelara on my August visit to dermatology

I'm going to run with there suggestions and then probably walk away and just stick with what I know unless the pain gets unbearable

[Fred]

walk away and just stick with what I know unless the pain gets unbearable

Take your own advice Jim.

If you can live with it then I would stay as you are, no point changing if the pain is bearable. Keep other options for later if/when you need them.

[jiml]

walk away and just stick with what I know unless the pain gets unbearable

Take your own advice Jim.

If you can live with it then I would stay as you are, no point changing if the pain is bearable. Keep other options for later if/when you need them.

I remember Paul9 having a very bad reaction to sulfasalazine which has tainted my thoughts a bit

[mataribot]

Jim,

I will give you a quick explanation of those drugs.

Sulfasalazine - this drug does not prevent bone damage. However, it some mild efficacy with symptom relief. Only DMARD that has symptom relief with the back. If you are allergic to Asprin or can't take it stay away.

Leflunomide - Shows mild efficacy in preventing bone damage in hands and feet. Doesn't help with psoriasis even know people try to claim it does.

The reason he is mad at you for not wanting MTX is because any combination of these drugs can be taken together. However, without MTX there is no psoriasis relief.

[jiml]

Thanks Matari so of the two leflunomide is the best for protecting the joints .....if I do need to go for one I will try that if I can take it with my Fumaderm (DMF )

But I'm not sure what to do as the pain is only bad in the mornings, and I don't feel inclined to add more drugs while the pain is bearable

So at the moment I'm just gathering opinion before my next meeting in a few weeks