New diagnosis of psoriatic arthritis

[KatT]

I started with a dermatologist who put me on MTX, which cleared my psoriasis very nicely however did nothing for the psoriatic arthritis. 

I was then referred to a rheumatologist.

For a while, I saw both specialists but was always stuck with the rheumatologist saying to consult back with the dermatologist because the treatment was prescribed by the dermatologist.

My dermatologist moved to another province and I didn't ask to be referred to another so now I only see a rheumatologist 

That being said, I am 100% clear of psoriasis (for now).  My main issue is the arthritis.

My rheumatologist does not have the greatest of reputation but he's the only one in our region unfortunately.

If you can find a good one, I would recommend seeing one.   They do verify the progression and damage done to the bones which I doubt a dermatologist would do....

[jiml]

Here my experience with rheumatologist was short lived
It started when I was getting arthritic pain and asked my dermatologist if I could increase my tablets as I was sure from what I'd read here that it would hold the arthritis back. He told me he didn't deal with the arthritis and referred me to a rheumatologist.
I went and saw her and did some scans to determine the swelling and bone damage she suggested I start on methotrexate I said no way and explained that the treatment I was on is tried and works in Europe and if I increased the dose it could help reduce the pain and wear. She said she knew nothing about DMF and couldn't prescribe a higher dose so we /I discussed biologicals she said I couldn't go onto them till I'd been through the methotrexate route. I said I won't go on that as I have had it before and it made me feel so ill when I was on it before... She referred me back to the dermatologist and said if he was OK for me to stay on the current treatment at a higher dose then I could do it. The dermatologist said OK let's try it and I've been on an increased dose for a couple of years now and as far as I can tell my arthritis is well controlled
So doubt if I'll be seeing a rheumatologist again anytime soon

[Kat]

Definitely varied responses on the rheumatologist.  Mine (rheumatologist) did say that some insurance companies here (in the US) require trying MTX first as it's cheaper but also said they were starting to get away from that.  But I was never prescribed MTX by either doctor.  They both (rheumatologist and dermatologist) worked together to determine which biologics to try.  Stelara was from the dermatologist, the Cosentyx and Taltz were decided upon by both (one concentrating on skin the other on arthritis.)  I DO feel like I may have had some good results with the Cosentyx as far as the arthritis goes but at that time the psoriatic arthritis was just starting to bother me so I'm not totally sure it helped,  but  I didn't feel the Taltz helped with that and none of them helped my skin. 

Since I didn't have any clearing on the biologics and the doctors were discussing what to try next, I put the brakes on when the pandemic hit.  Right now I'm using lotion (prescription - Talconex) for the skin and sadly am noticing a bit more issues with the arthritis.  I just wasn't interested in trying another biologic at this time since none of them had helped.

I do think that for here in the United States if you have psoriatic arthritis a dermatologist may not be the only one you should see, but that is just my opinion.  If you have a trusted dermatologist who feels like they can oversee the psoriatic arthritis as well then that would probably be sufficient.  Everything here is just so specialized that my dermatologist felt that my rheumatologist was better to handle the arthritis side of things as he has more experience with it.  They consult with each other so I'm happy with both.

Different health systems and just different opinions in general. 

[Turnedlight]

We have a drugs route doctors have to follow called the NICE pathway, and it basically means you have to go along it trying every cheap, old and outdated drug before eventually getting to things you can actually live with.

It’s about time they stopped insisting everyone go on mtx it’s a horrible zombie drug and I’m so grateful it stopped working on me or they’d probably still have me on it going around feeling like Theoden in lord of the rings

There are more bios to try, I got nothing from Taltz or Humira, but there are quite a few more. I have found here that the arthritis side takes precedence, so while they were originally prescribing drugs to improve my skin, once I got the psa they are only really interested in the drug working on that. I’m currently on benepali which is basically etanercept, it took quite a long time but I actually think it’s helping my psa now.

[jiml]

We have a drugs route doctors have to follow called the NICE pathway, and it basically means you have to go along it trying every cheap, old and outdated drug before eventually getting to things you can actually live with.

It’s about time they stopped insisting everyone go on mtx it’s a horrible zombie drug and I’m so grateful it stopped working on me or they’d probably still have me on it going around feeling like Theoden in lord of the rings 

There are more bios to try, I got nothing from Taltz or Humira, but there are quite a few more. I have found here that the arthritis side takes precedence, so while they were originally prescribing drugs to improve my skin, once I got the psa they are only really interested in the drug working on that. I’m currently on benepali which is basically etanercept, it took quite a long time but I actually think it’s helping my psa now.

great you are seeing or feeling improvements TL

[Mcduffy1]

We have a drugs route doctors have to follow called the NICE pathway, and it basically means you have to go along it trying every cheap, old and outdated drug before eventually getting to things you can actually live with.

It’s about time they stopped insisting everyone go on mtx it’s a horrible zombie drug and I’m so grateful it stopped working on me or they’d probably still have me on it going around feeling like Theoden in lord of the rings 

There are more bios to try, I got nothing from Taltz or Humira, but there are quite a few more. I have found here that the arthritis side takes precedence, so while they were originally prescribing drugs to improve my skin, once I got the psa they are only really interested in the drug working on that. I’m currently on benepali which is basically etanercept, it took quite a long time but I actually think it’s helping my psa now.

great you are seeing or feeling improvements TL 

[Mcduffy1]

Hi Nancy
Welcome to the group    I too am an RN -from Long Island NY. Psoriasis is crazy - I was Dx with Vitiligo first then moved on to Psoriasis & PA. Currently on Taltz -will never be the same as years ago but had my pity party & had to move on. This is a great group of people who support one another -keep your chin up -   we know that we really need to be thankful for everyday especially with what we see in our profession these days 
Denise

[Turnedlight]

Here my experience with rheumatologist was short lived
It started when I was getting arthritic pain and asked my dermatologist if I could increase my tablets as I was sure from what I'd read here that it would hold the arthritis back. He told me he didn't deal with the arthritis and referred me to a rheumatologist.
I went and saw her and did some scans to determine the swelling and bone damage she suggested I start on methotrexate I said no way and explained that the treatment I was on is tried and works in Europe and if I increased the dose it could help reduce the pain and wear. She said she knew nothing about DMF and couldn't prescribe a higher dose so we /I discussed biologicals she said I couldn't go onto them till I'd been through the methotrexate route. I said I won't go on that as I have had it before and it made me feel so ill when I was on it before... She referred me back to the dermatologist and said if he was OK for me to stay on the current treatment at a higher dose then I could do it. The dermatologist said OK let's try it and I've been on an increased dose for a couple of years now and as far as I can tell my arthritis is well controlled
So doubt if I'll be seeing a rheumatologist again anytime soon

That’s interesting because you’ve already done the methotrexate route (albeit for skin).. I was not asked to do it again for the rheumy.. and the rheumy lets the derm do all the prescribing.
I wish I could get my derm interested in dmf.

Sorry, not wishing to hi jack the thread..