Intramuscular Steroid injections

[Soreknees2016]

I suffer from Psoriatic Arthritis with flare ups normally occurring only once a year, although they now seem to be increasing in frequency. I am not currently on any regular meds for this because of the infrequency of flare ups, although I have in the past had intramuscular injections of kenalog.

So last night the pain started in my left ankle and right knee, and while it's really painful, I have had it much worse. My question is should I get an injection as soon as possible to try and prevent the pain getting any worse? In the past I have typically waited until pain is unbearable and has gone on for a while before contacting the hospital, especially as the rheumatology secretary who I have to call is a bit of a Rottweiler!!

Would really appreciate if anyone can advise if there is any benefit either way.

Many thanks!

[helixhelix]

Inflammation can lead to excess synovial fluid sloshing round your joints, and it is that that causes bone erosions. So knocking the inflammation on the head ASAP reduces your risk of permanent damage.

So Rottweilers be damned, it's your body and your joints at risk so I would suggest you make that phone call today.

[Downtime]

I have PSA too and flare ups once or twice a year. Like you I usually wait until the pain gets unbearable and i can't walk before getting a steroid shot. I think it's because I know you can only have 3 or 4 a year and I don't know how many or how bad the flares will be. Next time though I'm definitely going sooner . I find I get really down in these flares.

[Nettac]

I have the same as you. I would get it sorted before it becomes too agonising. My toes are really damaged through leaving things too long ( though not my fault!).

Good luck.

[James53]

As a fellow PA sufferer I would urge you to go for injections ASAP. Important also to be on maintenance injections to try and control ongoing inflammation.

[Soreknees2016 in reply to James53]

Thanks James - maintenance injections have never been mentioned to me, only allowed one a couple of times a year max in the event of a flare up. How often do you have injections?

[James53 in reply to Soreknees2016]

Sorry - not maintenance injections but meds.

[James53 in reply to James53]

Before going on to Benepali I was on Methotrexate meds but had injections into various joints as necessary. In addition I had general steroid injections (in bum) maybe every 4 months or so.

[nomoreheels]

I don't have PsA but RD though I'd certainly book that appointment, toffee to the rotty secretary! It's inflammation which is a huge warning sign of likely damage if not attended to, in your case with steroid injections as that's your Rheumy's way of treating you so remember it's not her incurring possible damage it's you. I hope she's fully fed & content when you ring.

[Hidden]

I'm a bit confused by this. It's the first time I've heard of PsA being left untreated unless it flares, even though the flares are relatively frequent - roughly once a year - and are severe enough to require steroid injections.

The main purpose of treatment is to prevent joint damage happening. The injections you're having aren't treatment as such, they just provide relief. Relief from pain doesn't stop the disease progressing. And although the flare ups must be horrible you have PsA all the time, even without them.

I think you should phone and ask for an injection ASAP. But I still wonder why you're not getting proper treatment that will control the disease, help to protect your joints and, possibly, prevent or at least reduce the flare ups.

[Soreknees2016 in reply to Hidden]

The decision not to start treatment was made jointly with my rheumy after he explained the potential side effects of DMARDs, and I myself likened it to taking a sledgehammer to crack a nut. However, what wasn't explained to me at all was the ongoing nature of PsA and the inherent joint damage, and I now feel quite aggrieved about this.

Even worse is that at my last appointment last May, the rheumy actually told me I needn't come back for annual appointments, unless anything changed. In October I had a really bad flare up affecting two joints and the doctor who administered the injection was concerned that things had indeed changed and that I should be looking at going on to meds.

I then got sent an appointment for 3 March which was subsequently cancelled with no reason given and no new appointment has yet been received!

Not a happy bunny tonight, so yes, an assertive conversation with the Rottweiler is on the cards for tomorrow!

[Hidden in reply to Soreknees2016]

I am so glad that you're re-appraising the situation. I honestly think the current approach to 'treatment' is quite bizarre and unusual. I know that people with very limited symptoms affecting particular joints are sometimes considered to have mild disease and take only NSAIDs, but it doesn't sound to me as if you fall into that category.

Yes the DMARDs may have side effects but the 'side effects' of PsA can be considerably more dramatic and life-changing. It is a whole body disease that can attack certain organs as well as joints. The more you know about it the better equipped you'll be to make decisions. I'm surprised that your initial and quite understandable concerns about DMARDs didn't generate more explanation and discussion with the rheumy.

My experience has been that some rheumys are not great when it comes to PsA, but there are plenty that are absolutely on the ball. The trick is to work out whether you're getting good care, bypass the resentment stage when it's lacklustre (that's not so easy!) and move on if necessary i.e. ask for a referral elsewhere. Actually that's quite a lot of hard work! But it can be worth it and then some.

There's a saying .... 'fear the disease not the drugs'.

[Soreknees2016 in reply to Hidden]

And just to add to the mix, I apparently have a Bakers Cyst, which I have never been able to feel, but today seems very prominent, but I not sure how this links in with PsA. Full of joy tonight!!

[Hidden in reply to Soreknees2016]

That's one for your rheumy obviously, but I'd say yes, very likely PsA.