PSA treatments - Moving from MTX to Biologics

TobyG_17

39 y/o Male - PSA since 2019 (& Psoriasis for as long as I can remember)

I was taking Methotrexate for 2-3 years, first via tablet & then by injection (after suffering with stomach issues/nausea). This was then supplemented with Sulfasalazine, but I took the decision to stop all medication as there was little to no relief from pain (although my psoriasis did improve slightly) & this was not worth it with the adverse feelings of fatigue and the impact the medication seemed to have on me mentally.

Following on from a recent MRI scan of my chest where further inflammation was found I have an appointment next week to discuss progressing to Biologics (adulimab). I wanted to know if anyone who has been on this medication journey knows if you need to be taking all three at once or whether the biologic can be used as a standalone?

I've felt so much happier and more like myself since being off the medication which has in itself made flare-ups easier to cope with. But I feel that I'm at a crossroads where I need to make a choice between being more physically healthy, or mentally healthy?

Any thoughts/feelings/experiences welcomed.

Much appreciated

chrisb

Hi @TobyG_17,

Welcome to the versus arthritis forum.

Here's a link to an article on our website which may be useful:

https://www.versusarthritis.org/about-arthritis/treatments/drugs/adalimumab/

Also, this fairly recent chat ma be worth joining in with:

https://community.versusarthritis.org/discussion/64134/adalimubab-biologics

I hope you receive some useful feedback from forum members.

Best wishes

ChrisB(Moderator)

Eeyore

Hello @TobyG_17

I have been taking Methotrexate by injection for over a year, with no side effects at all. Or much relief from R.A.! I had Hydroxychloroquine added, but that was awful and I was taken of it p.d.q., and was prescribed Adalimumab (which also has had zero side effects and very little reduction in the pain, etc.!, think I'm just unlucky there). I was told that Adalimumab and MTX together work much better than Adalimumab on its own. But this is something to be explored at your appointment, I know some others on here just take a biologic without MTX. We are all different and our bodies all react in different ways, it is, I'm afraid, a case of "trial and error". Keep an open mind until your appointment, you can't decide until you have all available information. Best of luck.

Arciere

hi @TobyG_17

I have a type of inflammatory arthritis that falls in the Spondyloarthritis groups - but notably no psoriasis. I have been diagnosed with PsA but I contest it thus my reference to Spondyloarthritis group.

I also started on methotrexate before moving to sulfasalzine before moving to Adalimumab (Yulflyma) as a standalone medication. I very much rate the drug and together with significant diet changes, I am able to live a normal life, despite ongoing and sometimes terrible fatigue.

Hope this helps

jamieA

Hi @TobyG_17

I was diagnosed with PsA in 2020 at the age of 65 and was put on 3gms of sulfasalazine daily. I've had psoriasis since I was 15. It didn't work and 3 months later MTX was added - ramped up to 20mgs weekly. The combination didn't work and 9 months after diagnosis the adalimumab biosimilar Amgevita was added. Within 2 months I was able to hand back the crutches I'd needed to walk and was in a much better place. The combination has continued to keep my inflammatory symptoms at a manageable level - I'm not cured by any means but I don't have the horrendous levels of pain I'd had previously. However I now have osteoarthritis in my knees, feet and hands - most probably caused by the PsA damage to my joints. My hands and knees were the first joints affected by the onset of PsA before the medics found a treatment regime that worked. I get really fatigued every week either the day after or 2 days after taking MTX but the fatigue isn't worsened by my adalimumab injection every fortnight. My psoriasis has cleared. I'm aware I'm immunocompromised and since my PsA diagnosis was during the worst of covid times I was very aware of the need to be careful . Whether I've let my guard slip or just been plain unlucky I've had 5 different infections in 2025 so far which has meant I've gone back to being extremely careful.

I hope you get a treatment that works for you soon.