When to upgrade to biologics

keith1971 Member Posts: 302

I have PSA and have been on methotrexate since the end of July slowly working up to 17.5mg.

The meds have had an obvious effect on my bloods (ESR & CRP being normal) but I still have issues with my knee, elbow & some fingers on my right hand. Pain levels are probably 3 on a 10 scale so I'm coping pretty well but my question is when is it appropriate to start the next level of treatment?

How bad must you be to qualify, i.e. is there specific criteria you have to meet?

I'm aware of the drip effect causing damage over time & would prefer to just turn the tap off if you get what I mean.

I'm seeing my rheumy nurse in a couple of weeks time so would like to discuss things then.

Many thanks for reading and any help you can give.



  • helpline_team
    helpline_team Posts: 2,769
    edited 30. Nov -1, 00:00
    Dear Keith,

    Thanks for your post to Helplines. This kind of enquiry is one that we are not qualified to go into in detail. In broad terms the biologic treatments may not be offered on the NHS if your methotrexate (mtx) was well tolerated and your disease was coming under control. Your rheumatology specialist nurse can go through the guidelines - they are different to the ones that apply to rheumatoid arthritis I think. Arthritis Research UK's booklet mentions that biologics may be used 'if other DMARDS aren't working well enough.'

    If you are having some on-going joint problems you may want to get the rheumatology people to see what they think - sometimes the joint problems may indicate either active disease, or some joint damage.

    The specialist organisation the PAA have some useful information http://www.papaa.org/tiki-custom_home.php

    I hope that is helpful

  • cthornley
    cthornley Member Posts: 627
    edited 30. Nov -1, 00:00
    You will need to fulfil the NICE criteria for prescribing - I'm not sure if they differ for PSA from RA but I can describe what they are for RA to give you an idea.

    You must have failed or not doing well enough on 2 or more DMARDs and have active disease.
    You are then rated on 2 seperate DAS scoring tests mine were a month apart.
    The DAS scoring tests are evil horrible points of torture but thankfully don't last too long.
    Firstly they assess a certain range of your joints (hands, shoulders, knees) for swelling, tenderness and pain (the evil bit - she pokes and prods asking does this hurt :shock: )
    They then ask you to rate how you feel overall out of 10 (marked on a chart)
    Then take your blood tests
    They then extrapolate a whole load of figures from this in a predescibed formula to give you a score. - you qualify if you get a score over 5.1 (i think) on the two occassions , this shows if you have active disease (its not a great test but its the one they use)

    You are then screened for a whole lot of nasties (I found out I had latent TB this way :eek: ) which can be made worse by the treatment.

    Then if you get through all that you can have Anti-TNF but if you don't show improvement within a certain amount of time they will take you back off it

    I'm on it now and i'm about to have my assessment to see if I can stay on it - touch wood should be fine because i've been much better since I started :grin:
    Hope that explains a bit - your docs can give you a much better idea about it, so I'd discuss it with them. I've also heard that they are being a bit harsh about it due to the costs involved so whereas they would in the past prescribe to borderline cases they may not do so know :sad:
  • keith1971
    keith1971 Member Posts: 302
    edited 30. Nov -1, 00:00
    Thanks a lot Chrissie, exactly the info I was after. Will discuss all of this with my rheumy nurse shortly.

    Quite why the Helpline team couldn't provide me with that answer is anyone's guess!!
  • valval
    valval Member Posts: 14,911
    edited 30. Nov -1, 00:00
    they have to be carefull as they not qualified to give this information and they might have a type of arther that does not get treated in this way. they do a great job val
  • helpline_team
    helpline_team Posts: 2,769
    edited 30. Nov -1, 00:00
    Dear Keith

    The information we give out is at the same level as our booklets and factsheets.

    Unlike Rheumatoid Arthritis, which has its own complete guidelines, the guidlines for psoriatic arthritis say you may be eligble for biological drugs, depending on where you live in the UK. For more information see our factsheet on Psoriatic arthritis at http://www.arthritiscare.org.uk/PublicationsandResources/Listedbytype/Factsheets#cK45.

    The information you were given by Chrissie , relating to RA is usefull, but as you have Psoriatic arthritis the criteria for treatment would be different.


    Helplines Team
  • tillytop
    tillytop Member Posts: 3,460
    edited 30. Nov -1, 00:00
    Hi Keith

    If you go to Google and type "nice ta 199" you will find the NICE guidance for the use of biologics in PA.


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