Self Induced Flare ?

jamieA

I've posted previously about me looking to reduce my medication intake of over 100 pills a week (for PsA and heart issues) as well as my bi-weekly adalimumab injection. Recently I'd met two other people with inflammatory arthritis who were only on biologics with no other arthritis drugs - whereas I also take sulfasalazine and methotrexate.

I saw a rheumatologist in mid February and she reluctantly agreed I could reduce my sulfasalazine in steps from 6 pills a day to 4. I did that and for the last month I've been on 4 pills a day - 2gms. A week ago I started having flare type symptoms but thought I maybe had a cold or flu. However it's a definite, significant flare and I'm back to being woke at 3-4am with hands that hurt and won't close. My shoulders, elbows, right hip and foot have joined in too.

So I'm now ramping back up to 3gms of sulfasalazine a day and hopefully back to normal. Meantime I've called the rheumatology nurse helpline to see if maybe a steroid injection would help.

So I think I've learned not to mess with my medication.

stickywicket

I think you're right in your assessment, @jamieA , but that doesn't make things any easier. I'm a big believer in taking as few meds as possible and have managed, over many years, to get my meth down to 10mgs weekly instead of 22.5. But that was over a long time and I'd been stable for several years.

I think one problem for you is that you clearly have an aggressive form of PsA and, as these things go, haven't been on the meds for very long. I do hope that the increased sulf will change things back for you and that, eventually, a further attempt will be successful.

Baloo

@jamieA hope your flare settles soon and you can get back to normal or even a new level of stable, one different enough you can try again.

jamieA

I spoke with the rheumatology nurse and she said that in her experience modifying existing rheumatology drug intake levels usually take about 4 weeks to show results. Since I started the sulfasalazine reduction 6 weeks ago and started a flare 2 weeks ago she'd put it down to that. I'll be back to 3gms a day on Thursday so she said don't expect to see results for a few weeks yet. In the meantime I'm back on painkillers. Co-codamol really didn't help so I'm now on Co-dydramol and if that doesn't work I've still got a stash of Dihydrocodeine and paracetamol. So the crazy thing about trying to reduce my pill intake has resulted in increasing it by almost 50% short term. If there's no sign of improvement in 2 weeks they will likely offer a steroid injection.

The rheumatologist's observation when I saw her mid February that the sulfasalazine, MTX and Amgevita working in conjunction provide a greater benefit than any single drug on it's own - what she called 1+1+1>3 - hopefully will revert to being true.

So the moral of the story is don't try to fix it if it ain't broken.