Cosentyx for psoriatic arthritis Fred's journey

[jiml]

Ohhh dear Fred it looks like it is time for a change, I hope you and your dermatologist can work out an option that will work for both your psoriasis and the psoriatic arthritis

Im like you and feel the rheumatologist just want to get you off a proper medicine and onto methotrexate and would rather deal with just a dermatologist

[D Foster]

My consultant does both rumatism and dermatology. The methotrexate is good if you don't have side effects, worked well for me and you can take it as an extra with your current treatment.

[Caroline]

That doesn’t look good Indeed Fred.
It seems really to be failing. Which basically means that you body is making antibodies for it that prevent the Cosentyx from working, your body fights the medication.

I think you will be up for a change then, which hopefully will help you again for a good time.
Can you perhaps ask the doc why the medication is failing, is your body fighting against the Bio-enzymes of the medication or whatever .. ??

Good the appointment is close.

[Turnedlight]

Ohhh dear Fred it looks like it is time for a change, I hope you and your dermatologist can work out an option that will work for both your psoriasis and the psoriatic arthritis

Im like you and feel the rheumatologist just want to get you off a proper medicine and onto methotrexate and would rather deal with just a dermatologist

Funny you should say that - last visit the rheumy nurse started talking about methotrexate and I had to be very firm..

[Fred]

Ohhh dear Fred it looks like it is time for a change, I hope you and your dermatologist can work out an option that will work for both your psoriasis and the psoriatic arthritis

Im like you and feel the rheumatologist just want to get you off a proper medicine and onto methotrexate and would rather deal with just a dermatologist

I've never managed to get one that does well for both for long Jim. My options are stay with Cosentyx, switch to Taltz, or see if she can prescribe Tremfya.

My consultant does both rumatism and dermatology. The methotrexate is good if you don't have side effects, worked well for me and you can take it as an extra with your current treatment.

I will never touch the stuff again Dave.

That doesn’t look good Indeed Fred.
It seems really to be failing. Which basically means that you body is making antibodies for it that prevent the Cosentyx from working, your body fights the medication.

I think you will be up for a change then, which hopefully will help you again for a good time.
Can you perhaps ask the doc why the medication is failing, is your body fighting against the Bio-enzymes of the medication or whatever .. ??

Good the appointment is close.

Yes I'm thinking my body has now got used to it just like it did with Stelara, if that is the case then my thinking is that Taltz wouldn't be any better as it's much the same stuff. I will ask  her why she thinks it is failing.

Funny you should say that - last visit the rheumy nurse started talking about methotrexate and I had to be very firm..

They love the stuff TL, but that is because they know there is nothing they can prescribe that will help psoriatic arthritis.

No better today, I had hoped it would be a bit better this morning but no joy.

[Fred]

Ok back from my appointment and it's goodbye to Cosentyx.

It's been a good 3+ years, but it's now failing and the psoriatic arthritis is coming back. It's never been great for the psoriasis, but that too is getting worse.

Apparently the biopsy showed that the rash and little bumps are a possible mix of eczema and psoriasis. I've never had eczema before and we still are not sure, but we decided that because the psoriatic arthritis is coming back we may as well move on. 

So my next try is going to be Tremfya. It's not authorised yet in France for psoriatic arthritis, but it is for psoriasis so we are going to give it a try and see if it will clear the skin and keep the psoriatic arthritis at bay. Recent studies are showing that it can help with psoriatic arthritis and they are filing for approval.

I'm disappointed as I have done so well on Cosentyx, but there is no point staying on it if the psoriatic arthritis is coming back and the the psoriasis/eczema itching is driving me nuts.

I will start a new thread about my journey on Tremfya when I start it in March.

Bye bye Cosentyx  it was good whilst it lasted.

[Caroline]

I was already waiting for your report on your visit. 

As you expected, it relatively clear that the Cosentyx is failing.

The eczema I don’t understand. That’s weird... eczema is an atopic disease and atopic diseases have the tendency to protect against arthritis.

It is from a study:
Decreased prevalence of atopic features in patients with psoriatic arthritis, but not in psoriasis vulgaris
Enes Hajdarbegovic, Tamar Nijsten, Anton Westgeest, Fred Habraken, Loes Hollestein, Bing Thio
J Am Acad Dermatol. 2013 Feb;68(2):270-7
ABSTRACT
Background: The prevalence of atopic disorders is reduced in patients with various au- toinflammatory diseases, but this association has not been studied in psoriasis vulgaris or psoriatic arthritis.
Objective: To compare the prevalence of hayfever, asthma and sensitization to common aeroallergens in patients with psoriasis vulgaris and patients with psoriatic arthritis to controls and to investigate whether atopy influences the arthritis activity and severity scores in psoriatic arthritis patients.
Methods: In a cross-sectional cohort study design, the differences in patient-reported lifetime prevalence of atopic disorders and serum immunoglobulin E directed against common aeroallergens were compared. The effect of atopy on arthritis severity was assessed using the Disease Activity Score 28 and Health Assessment Questionnaire. Logistic regression models were used to calculate crude and adjusted odds ratios with 95%-confidence intervals for presence of atopy.
Results: One hundred and sixty-eight patients with psoriatic arthritis, 133 psoriasis vulgaris patients and 147 controls were included. The life time prevalence of hayfever did not differ across groups. Patients with psoriatic arthritis were less likely to have suf- fered from asthma than controls; adjusted OR=0.20 [CI 95% 0.04-0.92] and they were less likely to be sensitized; adjusted OR=0.50 [95%CI 0.25-0.99]. HAQ-VAS for pain and HAQ-VAS for patient global score were significantly reduced by sensitization to common aeroallergens (beta-coefficient -0.54 [95% CI -0.84 - -0.25] and -18.4 [95% CI -28.5 - -8.25] respectively.)
Limitations : This is a cross-sectional, small numbered study.
Conclusion: Atopy may protect against development of psoriatic arthritis and diminish
its severity.
Key words
Atopy, asthma, hayfever, psoriatic arthritis, psoriasis vulgaris, life-time prevalence
Capsule summary
The prevalence of atopic disorders is diminished in rheumatoid arthritis.
The prevalence of atopic disorders is also diminished in patients with psoriatic arthritis. Atopy may be a risk determinant and a severity predictor for psoriatic arthritis.


Not that it will help you, but it seems a bit odd.
I read it in an article in the Dutch magazine of the Dutch patiënt Organization.

Anyway, you are going to try tremfya, the next step. Who knows what it will bring. I will give my best hopes for you.

[Fred]

Yes I don't understand why eczema was listed in the results, neither did my dermatologist. She did say as they marked it as possible we couldn't be sure, but it wasn't anything bad going on.

Like you say though, I'm moving on now so we will just have to see what happens. At least if it doesn't help the psoriatic arthritis I still have Taltz to fall back on.

Also it confirms how difficult we are to treat and you never know how things will change as you go on. I've had it for 40 odd years now and it always throws in a little twist just to remind you that you have it.

Time to move on and try something else.

[jiml]

Shame the Cosentyx is failing Fred and yes it's time to change. Let's hope the tremfya will give clearance to the psoriasis and psoriatic arthritis and the bumps will disappear by themselves as the Cosentyx leaves your system
I'll watch with great interest how it works for you

[D Foster]

I will keep my fingers crossed for you Fred and hope that the new treatment works for you.