Dermatologist to see me Weds., said I need biologic treaetment

[araorun]

Hi all, 

So I had a day yesterday. I went to my rheumatology referral and the doctor literally said, "I don't treat psoriasis; I treat psoriatic arthritis, but you don't have that." However, she said the awful outbreak and heard me tell her I have limited time to see doctors due to my job. She was the University of Tennessee group, and she got me into a UT dermatology clinic that afternoon. They tried to draw blood that morning, but I was severely dehydrated because I had bottomed out the night before due to low sugar and my ex had to come stay the night with me to make sure I was ok. So they couldn't get any blood; they said the derm would get it. 

So i get to the dermatologist--he understands how severe this is--however, he said he couldn't start me on anything until the blood tests came back and made sure everything was OK. He did say he believed I needed a biologic treatment, and in order to get that, I needed to see him at his other practice. He tried to get me in Monday, but it's Wednesday. Derm nurse couldn't get blood and told me to go back to rheumatology to get it drawn. Drove back across town, begged and pleaded, told them I could not return Monday because of my job, and they called a nurse who got it the first stick and drew 8 vials. 

Not sure what they will put me on, but the dr also said he saw the severity of the situation and asked if I could make it downtown 3 days a week for light treatment... I'm assuming he meant UV, he said it was like a tanning bed... I told him no, I can't do that because of my job. 

they also told me the ER should never have put me on predisone because it can actually make psoriasis worse! I told them it didn't, it actually cleared it up. Then they gave me a scrip of topical steroid OINTMENT, not cream, to use until I start actual treatment. 

So.... knowing they are looking at the biologic route, depending on bloodwork, etc. ... can anyone tell me a little more about that? Is it oral, or injections? If you have taken biologics, how effective have they been? Are there multiple different biologics? Has anyone experienced more help with one versus the other? etc.

I appreciate any pointers... I told the dr thanks to the board here I knew about biologics and he said "Sounds like you have done your research," which I thought was funny since I actually don't know exactly what a biologic is or how it's taken! but... excellent derm. Am still shocked my PCP kept sending me to rheumatology then I got there and the rheumatologist was like, "I don't treat this." I think she saw I was on the verge of a breakdown, hence the same-day appt with a derm. 

thanks for all you guys advice and support....

[jiml]

Hi Araorun I’m glad you have been seen by a dermatologist now and I’m glad the forum has been helpful to you, and you are doing the right thing asking questions, although we don’t have all the answers there is a wealth of practical knowledge here
Biological drugs are by injection or infusion and can be done by yourself at home after being taught how. This thread explains the different Biological drugs  Biological Treatments For Psoriasis

They will probably start you on humira although some dermatologists are prescribing cosentyx quickly... I think a lot will depend on what your insurance will pay for and approve

Many of our members are on biological drugs and I’m sure they will tell you of their experiences....

Good luck with which ever one you get  

[mataribot]

There are many biological drugs to take, but typically the first ones to try are tnfs. There are two different ways they are administered - either through injection or an infusion. They typically start off with Remicade (infusion), however since your diabetic an infusion may not be the best choice. The stuff they mix with the drug to give you the infusion will temporarily raise your blood sugar. If they decide with a tnf, I would suggest Humira.

If you have a choice of medication, I would suggest Stelara. This drug is different than tnfs and works faster than tnfs and has less chance of failing.

[mataribot]

The side effects of Biologics can be scary, but try not to be scared. In my opinion they are safer then over the counter NSAIDS

[Caroline]

There are many biological drugs to take, but typically the first ones to try are tnfs. There are two different ways they are administered - either through injection or an infusion. They typically start off with Remicade (infusion), however since your diabetic an infusion may not be the best choice. The stuff they mix with the drug to give you the infusion will temporarily raise your blood sugar. If they decide with a tnf, I would suggest Humira.

If you have a choice of medication, I would suggest Stelara. This drug is different than tnfs and works faster than tnfs and has less chance of failing.

I can go along with Mati. Good suggestions. Over here at the board we have a bit the impression that TNF's (which are proteins), which are biologicals that block a messenger pathway in your immune system, do have the tendency to fail in a certain time as you will be building up anti-bodies against them. Eternacept (Enbrel) would in that sense be a good one as you will not build up anti-bodies with that.
As for the Stelara, that is another type of biological, it connects and blocks interaction mainly to receptors on your cells, in the case of Stelara that is (IL-23) an interleukin that seems to have much to do with Psoriasis. We have very good experiences with Stelara here at the board.
Most biologicals are types of monoclonal anti bodies.

Question: did your ancestors also have Psoriasis? If so then at least you may have a hunch that it has a genetic cause.

[Bill]

I hope you get onto an effective bio soon. They can work very quickly.

[Fred]

Good to hear you are finally getting somewhere.

Like Jim said this thread will give you the basics of each one Biological Treatments For Psoriasis

They are taken by a small injection under the skin or in the case of Remicade given by infusion at the hospital. Remicade used to be the starting Bio but today it's not used so much as the under the skin shots are better and easier for the patient.

I'm a huge fan of the Bio's as they gave me back my life, I've been on them about 10 years now and apart from reactions to the TNF type I have done very well on them and no serious side effects. Most side effects are Flu like feeling after the shot, but as your body gets used to them it doesn't last so long. It may take a while to find the right one for you. but there are currently 11 in use (See the list from the above link)

Personally if I was you and you are offered a choice I would go for Stelara. It works very fast and the maintenance dose is 1 shot every 12 weeks.  

Apart from Remicade once they have trained you how to do it you can do the shots yourself at home. It's a simple matter of pinching an inch of skin and sticking the small needle under the inch of skin. *Some do come in a Pen type injector but most people find they sting, so ask for the normal syringe type shots would be my tip.

Good luck.

[araorun]

I'm not concerned about doing an injection. I'm a type 1 diabetic. 

Well, the derm appointment yesterday was very disappointing. They could not find my blood test results and so could not start me on any meds, although he wrote on my treatment plan he wants to start humira. but first i had to let them redraw the blood... then he did a biopsy?? the resident who did it said they were doing it to be sure it was psoriasis... what else would it be? then they stitched me shut and i'm to return in two weeks to remove the stitches, get the biopsy results and HOPEFULLY START TREATMENT. 

I know the dr is being thorough, however, I was in his office last week... why did he not do a biopsy then? and how can they lose bloodwork??? at least I'm on track to get treated.. the topical steriod is helping a lot, both with the actual psoriasis and keeping down the swelling. And they gave me a HUGE tub of it, with refills. But I'm so disappointed I have to wait two more weeks. It could be worse... but never heard of a biopsy for psoriasis? And I'm still stuck on why they didn't do the biopsy when I saw him last week instead of waiting until yesterday... with no warning... ugh. 

thanks for all your replies... not sure if this is "for sure" or not, but he did put down on my treatment plan that eventually he plans to start me on humira.

[Fred]

I've had a few biopsy's I started a thread about it a few years ago Psoriasis Biopsy it does help them get a 100% diagnoses, there are some other skin problems that can look like psoriasis. So a biopsy is worth having to be 100%

Mine have always been done at the dermatology appointment, so a bit odd that they didn't do it then.

Hope you get sorted soon.