Question

[1pepperdog5]

While I don't have rheumatoid arthritis, because it in every joint, it's just confined to my knee at the moment, they say it's imflammitory arthristis becuase it's confined to one area, I am on Methotrexate for the last 6 months, and I've just noticed a lot of spots appearing on my neck and some on upper back. I am on the max dose of 20mg. I would be appreciate it anyone could tell my if they have experienced this too

[Hidden]

Hello 1pepperdog5. I am not a doctor, I sell beer for a living. That being said, my hubby had a simular scenario. Swollen knee and then spots on his stomach. Turned out to be psoriatic arthritis. Please see your doctor about this. Don't worry, the they use the same meds for this. It's just a nice piece of mind to know exactly what your diagnosis is.

Take care

Sue

[farm123]

Mine started 30 years ago in just my left knee but now many joints are affected. In letters mine is referred to as 'sero-negative inflammatory arthritis'. Worth a check with rheumy nurse/GP re spots in case it is a reaction to MTX. Farm

[helixhelix]

Inflammatory arthritis is a general term which covers a number of these diseases. A bit like you've got a box full of fruit, but you can't see what's inside the box - lemons, cherries or bananas.

Quite often it takes time, even years, for the disease to show itself as rheumatoid arthritis, psioriatic arthritis, or spondlylarthritis so until then they use the general term. So don't worry too much about the name, but concentrate on whether the treatment works.

[mirren]

The issue becomes more pertinent if treatment doesnt work... if you have guttae psoriasis (google for pics yo compare) then you are likely to have PsA. And PsA is less likely to respond to DMARDS like mtx. To educate yourself about your comdition and treatment you do need a diagnosis unfortunately. If the treatment is working of course then it doesnt matter. I am in limbo with a query PsA (i dont have psoriasis though)query connective tissue disease so im not able to wave any NICE guidelines around. Good luck and if it does turn out to be psoriasis/PsA then beyond psoriasis is a small but supportivd group on HU. Though have to say the NRAS community were my lifeline when i first got sick and was suspected RhA and even now.

[flow4]

I have just had my dose of methotrexate increased from 15 to 25mg, and switched from tablets to injections, and I have developed a pimply rash on my arms. It looks like heat rash or a contact dermatitis, and I assume it is a drug reaction. It's mild, so I'm ignoring it at the moment - I have found that previous side effects to different meds have generally settled after a few weeks, so I'll wait and see if this does too.

By the way Mirren, though it's generally thought that PsA is less likely to respond to DMARDs - or was - methotrexate is an exception: it is specifically given to treat severe psoriasis, and is effective, so it's unlikely that someone wd get a new flare of psoriasis caused by it. I have PsA and am on mtx, and under the care of one of the UK's top rheumatology departments.

[mirren in reply to flow4]

Flow I wasn't suggesting that her rash was caused by mtx - but that if her new rash turns out to be psoriasis then it will most likely push her into the PsA box rather than the vague limbo that is inflammatory arthritis.

And while Methotrexate may help some PsA sufferers, (I have been on it a almost a year) there is research out there that says it merely acts as a symptom controller in some people and not as a disease modifier. More importantly, NICE guidelines for PsA have been written with this issue in mind. As PsA is less likely to respond to DMARDs, people who do not get remission from 2 consecutive or simultaneous DMARDs over a 3 month period should be considered for biologics. In RhA it is 3 DMARDs. In undiagnosed inflammatory arthritis there are no clear guidelines, in fact, you are less likely to be offered biologics. So diagnosis can make a significant difference to your management as therefore outcome.

I am going to an emergency rheum nurse appt on Thurs as I am struggling badly with foot and anklepain, wrist and elbow pain. Because I have this ? MCTD label in the way and no psoriasis to support my PsA diagnosis, I had Hydroxychloroquine added and my mtx dose titration got put on hold for 6 months. I have to say I was very sick at time and i did get an improvement of about 60%, but no remission. Now I realise I still have to get up to 25mg of mtx (currently on 20mg and 400 Hydroxychloroquine daily) and Hydroxychloroquine isn't actually n PsA DMARD list so won't count as second DMARD.

So for example:I if I am not lucky enough to be one of the people who responds to 25 mg Mtx or my next DMARD (probably leflunomide which is perceived as more effective in PsA anyway if tolerated) it could be almost another year before I (or similar case) am assessed fr biologics, as waiting for appts and titration all takes time. Meanwhile 2 years of damage continues, life gets harder, careers destroyed, relationships suffer....

After saying all that I really hope your 25 mg helps Flow. If after 3 months it hasn't insist on changing or adding a second DMARD. If not in remission after 3 months on that, ask for assessment for biologics. I am not able to do that as I can't officially 'prove' my PsA ...... good luck xx

[flow4 in reply to mirren]

I'd qualify for biologics as my next 'step', mirren, I think, because I tried hydroxy before mtx. Ironically, it triggered the flare of psoriasis that got me diagnosed with PsA. I hadn't knowingly had psoriasis before, although I've had various 'skin problems' and rashes over the years... Turns out some of that was psoriasis...

[mirren]

Although Methotrexate is proven to be effective in psoriasis its not doing so well in a few papers on PsA. Enough for me to be a little anxious about my rapidly deteriorating wrist range of movement and my walking ability.

I am not sure if Hydroxychloroquine counts as a DMRD in PsA though...iits not on the list of DMARSs only mtx sulphasalazine and leflunomide are. other drugs may occasionally be used. my mum had cyclosporine and mycophenolate. none worked but she never got biologics as she had severe COPD. Her immunosuppressive therapy caused chest infection after chest infection to become pneumonia after pneumonia and killed her in the end at 66.

If Hydroxychloroquine counts then i will qualify if i fail to improve on increased Methotrexate. I would prefer mtx to work or to try leflunomide and for it to change my life, but I don't hold out too much hope. I am also on a Psoriatic Arthritis UK Facebook forum flow, its not so informative as this forum as its layout doesn't lend itself to searching for answers to questions. What it does have is thousands of members who know the pros and cons and ins and outs of PsA and there are enough people on there who are becoming very disabled while waiting to qualify for the big guns for me to be less confident in mtx.