Possible Psa diagnosis now

[Downtime]

My original diagnosis was RA 18 months ago but MXT has never been very successful. I was in pain every day. The only thing that helped was NSAIDs but the doc said I shouldn't be taking them along with the MXT. The last appointment with rheumy I showed him what I thought was psoriasis on one leg . Very small patches which improved with the sun. He then prescribed brufen retard every day for 2 months along with MXT then see him again. It's been amazing I feel almost normal. I still get the tiredness if I overdo things but altogether do much better.

Has anyone else experienced this with Psa? If so can I keep taking the NSAIDs indefinitely. I think not! It's so good not having awful back and hip pain all the time.

[earthwitch]

I have ankylosing spondylitis, which is in the same family as PsA. NSAIDs are usually the more effective treatment than DMARDs for this type of inflammatory arthritis, and are usually the first line treatment. I've known some folk take them for 30 years or more without any real problems. I was able to take them for probably 10 years intermittently, and five years continuously (at full prescription strength). I know there are warnings on them, and they can be harsh on your gut, but for spondyloarthritis they can be really useful for as long as you are able to safely take them. Its a case of weighing up the risks and the benefits. If you are just using them as pain relief, then the risks are probably more than the benefits. if you are using them as an antiinflammatory to deal with spondyloarthritis, then the benefits are probably more than the risks (at least up to the point where you are having problems with adverse reactions), but that is something to discuss with your doctor.

[Downtime in reply to earthwitch]

If it is spondyloarthritis I understand that it isn't as erosive so maybe the NSAIDs are all I need. The rheumy did say when he next sees me I might be able to reduce the MXT so wait and see what happens but at the moment I'm feeling good! Thanks

[Hidden]

Isn't brufen ibuprofin? Which is a NSAID. I would ask your doctor to clarify how long you can take it.

I wish you well

Sue

[Hidden]

Hi there,

if Mtx hasn't helped control the PsA then according to the NICE pathways you should be moving on to another DMARD. And then if that doesn't work you may meet the criteria for biologic therapy. NSAIDs make me feel a lot more comfortable too, but PsA is a degenerative, potentially destructive disease so controlling pain is a very different matter from controlling the disease process.

I know NSAIDs are anti-inflammatories, but as far as I know they are really only used for pain-relief in PsA. In terms of calming the actual disease I think it's probably like chucking a few buckets of water at a forest fire. Plus long-term NSAID use isn't good for you.

Has your rheumy said anything about a treatment plan?

[Downtime]

Thanks, Postle I was thinking along those lines myself. I'm going back in 2 months so I think he's really just maybe confirming the diagnosis by giving me the NSAIDs then he will decide what is next. I live in the Channel Islands and I don't think we have to adhere to NICE guidelines here, but we'll see. I dont really want to take bio logics. I think my Psa is fairly mild but the problem seems to be with the tendons which get very inflamed. I haven't had a back X ray but everywhere else seems ok, without erosions.

[Hidden in reply to Downtime]

I realised after my reply that your rheumy was probably still in the process of exploring the PsA diagnosis. I suppose I just wanted to jump in with the message that NSAIDs aren't really 'treatment' for PsA, they're used as painkillers predominantly, as far as I know. For AS I think they are the first line of treatment for possibly quite a while but then the guidelines allow for a jump straight to bios (again, that's just what I recall from looking at the NICE guidelines).

It's weird that NSAIDs which can be bought over the counter are actually pretty tough on the body if used long-term. Whereas the bios that you have to jump through hoops for are possibly a whole lot easier on the body. Anyway, it's worth pondering / checking out a bit of research on bios because while common sense decrees that the more 'aggressive' treatment would have more side effects etc. than other treatments, I understand that that is not necessarily so.

You know, I'm not sure how much any treatment helps with the tendon issues which are so common with PsA. Possibly certain drugs help a lot, but I've not found any convincing answers to that one.

I hope that the Channel Islands do provide well for you and good luck at that next appointment.