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Where next with PsA?

Just wondering if anyone else has any knowledge of whats " likely" to be my next treatment for Psoriatic Arthritis. Been diagnosed now for about 20 months, its in pretty well every joint from head to feet to different degrees from just stiff to constant pain, though I do not get the impression I am regarded a severe case. I have 3 visibly swollen joints on my hands and noticed some new swelling recently at the ends of my fingers now ( characteristic of PsA).
I have been on MTX for 16 months ( can't say I notice any improvement from being on it, though its cleared up my very trivial Psoriasis) and have tried Leflunamide for 6 months and Sulfasalazine for coming up to 6 months). The Lef. did nothing of note though the Sulfa did appear to abate things noticeably for 3 weeks in summer ( I am crediting it with this I have no way of really being sure) but its since got worse again.
I am due to see the rheumy in 3 weeks and was wondering if anyone has any knowledge of what is likely to be tried next. My hope is Biologics, and in fact one of the rheumy nurses thought I should be trying them in the Summer but was over ruled by the rheumy ( apparently I "don't meet the criteria"). I feel I am wasting my time with any other stuff, most things I have heard from the one other sufferer I know, and from rheumatology stuff I read on Twitter and through my own extensive research seems to suggest the only really effective drugs ( and even then its hit and miss with no guarantee's) are three of the biologics- Humira, Enbrel and Remecade. My friend eventually got Remecade and it went away 8 years ago and he has remained in remission a further 4 years since stopping it.. I look at the well known golfer Phil Mickelson, winner of the Open this year- he was put on Enbrel, after 3 months of MTX and look what he can do! I can barely walk round the block.
Anyone here know? I feel I am being strung along following the flow chart on the SIGN guidelines, they seem to suggest Biologics next BUT if I "don't meet the criteria" which seem very subjective, it seems my hopes of getting some releif/remission are going to be slammed on cost grounds not clinical benefit.

I think the best thing to do is have a really open discussion with your Rheumatologist and ask why you don't meet the criteria. Advise him that you understand the guidelines but you would like a better explanation - it's not the first time I've left Rheumy clinic just to phone back up later on that week with a list of questions. I have been able to leave these questions on the Rheumy's Secretary's answering machine and have been 'lucky' enough to have a good consultant twho gets back to me within a few days.

Apart from that, I would recommend you attend one of our self management courses, which helps to give you different coping strategies to try alongside medications. If you are interested, contact Alex at [email protected]

Our free helpline given at the top of each page on this website will also give you some guidance.

Let us know how you get on.

Kind regards

Thanks mel. I spoke to a chap on your helpline on Thursday who was very helpful. 10 days to go so time to get prepared for "war"! BTW I think you need to consider some anti spam measures for your forum, and review some of the accounts, looks like your getting spammed by bots. A Captcha on the registration page would be a start.

Hi the unfamousfly - SO GLAD you contacted our helpline and it was useful for you. Please keep in touch and keep us up to date with what's happening.

Re the spam - absolutely - as this is Arthritis Care Scotland's NEW website - some bots and spam have been filtering through despite out anti spam measures - we are on it every day but I will certainly pass on your recommendation to our website designers. Thanks for that! Please let me know if you have any more comments! We would appreciate them all!


Went to see Rheumatologist today. Left feeling utterly despondent.
I am not sure they know what is wrong with me. Apparently the slight ( newer) swelling I have on my end finger joints are called Herbedens Nodes and he says are more symptomatic of Osteoarthritis. He said the swelling on my fingers and hand while clearly visible isn't the type of swelling that would be clinically acceptable to qualify as swollen joints under the licencing arrangements for biologic treatment, whether via NHS or Privately. I have some slight joint erosion on my right big toe- though ironically its my left one thats been causing me grief recently and making walking hard ( on top of everything else) . Basically there seems to be some doubt whether I have Psoriatic Arthritis, or Inflammatory Osteoarthritis- or a bit of both.. I have to stop taking Sulfasalazine but they are going to bang up my MTX to maximum dose ( which I am not delighted about) it doesnt ever feel like its done anything for me though it does seem to have cleared my skin Psoriasis. Its just so unpleasant to take. Adding another 5mgs isnt what I want to be doing. I have to go back in 4 months. If I make it that long.

Hey unfamousfly,

Interesting reading your blog, how are you today? Sounds like you are have a time of it, let me know if I can be of any help?