Hi I am new here

rajneesh1983 · 3. Sep 2015, 04:55

Hi Friends,
After going through the forum and reading supportive feedback, suggestions and views of experts and members I feel this forum is really guiding people in need and hence I joined this Forum.
Two weeks back, my wife was diagnosed with Psoriatic Arthritis (PsA). I will start with the case history of my wife, she is 32 now. She has Psoriasis (Ps) since she was 15, it is hereditary. She started with homeopathic treatment in India. Continued homeopathy for quite a long time, which actually cured her cough and cold entirely(which were again highly persistent) but Ps kept on increasing. Then when Ps became almost disabling she moved to mainstream treatment. Below is the timeline of diagnosis and treatment.
1999 to 2002 - Topical steroids
2002 to 2008 – Homeopathic Treatment
2008 to 2010 – Topical steroids
2010 to 2013 -- Methotrexate - 2.5mg x 3 per week (Stopped Methotrexate after June 2013 due to intolerance)
2013 to Nov 2014 -- Topical Tar oil mixed with some steroid creams
Nov 2014 to Till Date – Dermovate & Daivobet topical ointments
After taking methotrexate for almost three years she stopped taking it in year 2013 since it was having adverse effect on her health (heavy nausea, vomiting, and other issues). Also, Psoriasis would instantly return even if she missed even one tablet.
In Nov 2014, we relocated to United Arab Emirates and started seeing a Dermatologist again. Right now she has Psoriasis on more than 40% of her body. Knowing the adverse effects of Methotrexate we continued with Dermovate and Daivobet against our Dermatalogists sugession to start Methotrexate. In mid-july 2015 she started having knee pain and found it difficult to stand up. We went to orthopedic he did x-ray and said some kind of muscle swelling and gave us anti-inflammatory. In couple of days both her index fingers were swollen, we went to see a general physician thinking it was infection he treated her for one week and then directed us to Surgeon who straight away directed us to another Orthopedic who treated us for another week with anti-inflammatory and conducted blood tests all came negative for infection. Orthopedic directed us to a Rheumatologist. Rheumatologist had a look at the blood test reports, x-ray did ultra-sound and confirmed that it was Psoriatic Arthritis. After knowing my wife’s history with methotrexate she suggested we go ahead with biologics – (Enbrel).
Both Dermatologist in Rheumatologist are very good and known doctors in UAE.
Our concern is Dermatologist wants to give methotrexate one more try and only then move to Biologics if methotrexate fails during his treatment, whereas Rheumatologist suggests us to go ahead with Biologics.
Without Dermatologist's (insurance network doctor) approval Biologics will be partly covered in our Insurance so we can either pay the part price (which we might be able to in a couple months) of Biologics or go ahead with Methotrexate again. We are really confused and stuck between these two options. My wife still has swollen knee and swollen index fingers.
Will be glad to hear your opinions and suggestions on this.
Thanks a lot.
Regards
Rajneesh

[Deleted User] · 3. Sep 2015, 07:44

Hello

Welcome to the forum. I am sure you will find support, advice, friendship and light relief here.

I am one of the moderation team, we all have one or more "Arthritis Hangers on" or look after family members who the same. If you have any problems with the technicallities of the forum please just get in touch via a personal message.

CK Moderator.

stickywicket · 3. Sep 2015, 10:50

Oh dear, your poor wife! She must have really been going through the pain barrier for so long.

We are very lucky here in the UK in that we don't have to think about the costs of our treatment unless we see a doctor privately. I have a son in USA so I can appreciate the added worries of financial medical provision.

I can only tell you what the thinking is over here ie the sooner we patients are put onto DMARDS (Disease Modifying Anti-Rheumatic Drugs), of which methotrexate is one, the better the outcome. Unfortunately, all the medication used to treat PsA, and other autoimmune forms of arthritis, can cause unpleasant side effects. Sometimes these will abate given time. Sometimes a different medication is required. Folic acid is usually prescribed to mitigate against the worst of the side effects of methotrexate. I take it twice a week and have had no side effects from methotrexate. Others take it once a week or up to six days per week (every day except their meth day) as directed by their rheumatologist.

It is difficult when the specialists disagree. Clearly your wife needs something but what? I can understand her reluctance to resume the meth but I wonder if she was actually prescribed folic acid with it previously. Also, over here, if meth works but the patient is nauseous on it, it is usually prescribed as an injection as this usually overcomes that problem.

I'm surprised enbrel has been suggested rather than other DMARDS. Many on here take it successfully (though no arthritis meds work for everyone) but, in UK, we usually have to 'fail' on three DMARDS before enbrel will be prescribed. There are other DMARDS besides meth. I take hydroxychloroquine as well as methotrexate. There is also leflunomide and, perhaps more relevantly for your wife, sulphasalazine which is often prescribed for PsA patients.

Try reading up on the medications here http://www.arthritisresearchuk.org/arthritis-information/drugs/dmards.aspx but please don't hesitate to get back to us if we can be of help.

dreamdaisy · 3. Sep 2015, 13:32

Hello, I empathise with your wife and yoursefl, I too have PsA but too much time elapsed before I was put on to the right medication so I have no wise words about what is the best choice. Some meds have a better effect than others, it is a matter of trial and error.

I took tablet meth for a while then developed a rash - it was stopped. I have been taking sulphasalazine since 2002 in conjunction with various DMARDs, anti TNFs and biologics. My current trinity is sulph, injected meth and injected humira. I am unusual in that I have the arthritis without much of the psoriasis but over time I have also developed osteoarthritis. Things are not going well and haven't been for some time.

I am surprised that your wife has not been offered injected methotrexate, that usually alleviates the nausea etc. I am fortunate in that I have not been bothered much at all by side effects with any of the meds I have taken but the trade-off for that appears to be little effect on the arthritis.

Deciding which meds to take is never an easy process, the docs make promises but no-one knows what will happen, one might strike lucky and one might not. I had to fail on three DMARDs (thus losing nearly five years of effective treatment) before I was given my first anti-TNF but the thinking has changed now and one can be given access to these drugs far quicker, which can only be a good thing.

Please let us know how things develop. I wish you both well. DD

rajneesh1983 · 7. Sep 2015, 07:07

Hi Sticky & DD,
Nice to hear from you guys but sorry to hear about your Arthritis. Thanks a lot for taking out time and replying to our query. You both are really helpful.

To give you guys an update. Today we went to American Hospital Dubai(AHD) for a second Rheumatologist opinion and to clear our confusion. He concurred the opinion of the 1st rheumatologist and said we should start with biologics. But said we need to conduct many tests before that which will take 2-3 weeks (Insurance approval to test result). After seeing the test results as well as insurance type he will suggest which biologicals to take. Till he decides on biologicals he said we will start with Methotrexate 1st.
After reading your(DD & Sticky) replies we were sure if we have to go back to Methotrexate it will be by injection only. So when doctor gave us an option today we chose injections. So today he gave 10mg methotrexate injection and Folic acid tablets.(Also one Anti-inflammatory)
Future plan is metho 15mg next week and 20mg week after that, if my wife takes it well. And we have to meet him after two weeks to discuss about Biologics.
Looks like we are going ahead with our Rheumatologist and not Dermatologist. I just hope it works out.
Thanks a lot for your responses. Needless to say, I will keep you guys updated.

Thanks,
Regards
Rajneesh

stickywicket · 7. Sep 2015, 14:46

Thanks very much for the update. What is proposed makes perfect sense to me and I do hope all goes well. Make sure your wife keeps up with the blood tests as they can reveal potential problems before they become serious. I wish you both the best of success.

Hi I am new here

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