Anyone switched biologic?

Hi

I'm at a point where I need to choose and would appreciate advice.

1. Stick with Imraldi and add sulphasalazine for re-emerging hand, wrist and back pain? (PsA)

2. Or try another biologic, which has been offered by dermatology?

I'm lucky that I've not had to wait too long with the aches and pains as I'm due to see Dermatology and Rheumatology soon.

Imraldi is prescribed and monitored by the Dermatology clinic and they have offered the biologic switch.

Rheumatology offered the sulphasalazine in October last year when I explained pain was re-emerging. The two clinics read the notes from each other and we have a brief chat about what the other dept in saying. I'm in a quandary but also aware that I'm fortunate that these appointments are coinciding soon...

Anyone switched? Would appreciate advice. I've went through lots of tablet changes recently for inner ear disorder/menieres symptoms and so mentally reluctant to change biologic but worried incase I need to wait too long...I don't feel I have the headspace for a big change in medication...

Been on imraldi since Aug 2019 and Dermatologist agrees it is great for my skin (all clear for first time in 20+ years) but also agrees it has now lost efficiency for my joints. Hands and wrists are very sore, shooting pains on wrists on and off all day. But clear skin is a godsend as the type of psoriasis I had was very sore, bled a lot and on all joints so my general movement was very stiff and painful and that is away now! What a relief there. (I'm not working so don't use my hands all day, I know that sounds daft but it is a factor too).

So - manage with the hand and back pain/strap up the hands and don't rock the boat re skin?

Or - switch?

I've no idea...Thanks x

[Ravey]

God knows Fuzzy..talk about a rock and a hard place ☹..someone on here is bound to have some Pearl's of wisdom for you 🤞 So pleased you have some releif at the moment..long may it continue 🤗..goodluck x

[Hidden in reply to Ravey]

Thanks very much...I'm in the 'if in doubt do nowt' mode I think. Still, I'm grateful my skin is clear. xx

[Ravey in reply to Hidden]

Yeah I live by that one ..usually the best bet I find..I bet you are bless you 😀..no streaking though lol x

[Hidden in reply to Ravey]

😄

[AgedCrone]

Well as you know we can’t offer clinical advice…but as the Imraldi is working so well for your skin…. Why don’t you either speak to your rheumy nurse explaining your dilemma…or send a note to your rheumy team asking their advice now …..so that they can speak to dermatology ahead of your consult …..many people do well on SSZ….so if Rheumy agrees to just add SSZ….I’d take that advice!But as you are needing to treat 2 different systems there maybe other RA drugs that are more compatible with your Biologic & your rheumy needs ?

Well….I think that’s what I mean! 😏

[Hidden]

Thanks - good advice xx

[Potatos]

No decision is final. You can add in the sulfasalazine and see if it works, if it doesn't ask for the biologics switch.

[Hidden in reply to Potatos]

Good point! I'll probably do that. Was probably just feeling anxious as I hate change. Thanks. x

[swapshop]

I started adalibumab last june . It was amazing so dropped my ssz. Sadly since the new year the pains crept back so i've started ssz again with the hope that it gets back to as great as it was.. so for me they seemed to work well together , but of course it could just be a coincidence 😂

[Hidden in reply to swapshop]

That is good to hear that they are working well for you. I think I've been worrying about potential side effects but think I will try sulph. Glad Adalimumab (imraldi) worked for a time for you, shame the problems re-occurred. x

[smilelines]

I would add the sulfasaluzine because the other is working so well on your skin. 😀

[Hidden in reply to smilelines]

Thanks. It is looking that way. x

[Knit12]

I was on sulphasalazine for over 20 years and while not perfect did help a lot and allowed me to have a life and work full time. 3 years ago it stopped working and 10 drugs later i have finally found a biologic that works for me. They all have various side effects, and some are worse than others. I would give sulphasalazine a try and if it doesnt work well you tried. It normally takes about 3 months to get into your system so maybe a steroid injection may help your symptoms, but like others have said, I would talk to your rheumatology team and see what they advise.

[Hidden in reply to Knit12]

Thanks I've had many steroid injections- all over body one and also a few ultra sound ones in my wrist. Thanks I think I will give sulphasalazine a try. I appreciate you replying. x

[DelicateInput]

I think there is a section on Health Unlocked for psoriatic arthritis. Different drugs are effective for it than RA - I think you qualify for biologics sooner as some drugs do not work on psoriatic arthritis which do work on RA.

[Hidden]

Hi

There is not much on the psoriasis and psoriatic arthritis health unlocked sites as regards the treatment I'm on. There is more here on joint pain management and biologic medication. PsA affects the tendons more but I still get good advice here on dealing with it. I think biologics have changed the landscape a bit as they're offered for a range of conditions. To be fair, my quality of life changed dramatically since going on Imraldi two years ago. Thanks for replying. x

[smilelines in reply to Hidden]

Oh! I did not know PsA effects the tendons more than RA.

[Hidden in reply to smilelines]

True enough...there is a lot of overlapping symptoms with PsA and RA...x

[oldtimer2]

My sister is on sarilumimab rather than adalumimab with a diagnosis of psoriatic arthritis. She has been on three biologics and this one is so successful they are suggesting that she actually reduces the dose. But she only has moderately affected joints (compared with me anyway).

[Hidden in reply to oldtimer2]

Thanks that's interesting x

[Evie3]

It is a difficult one. I have had 3 changes of Biologic over several years….all 3 being effective for about 9 years when their efficacy waned so the choice to change was made for me really. The pain I experienced was unbearable so was given a steroid infusion over 3 days that helped in the interim. Bear in mind if you choose another biologic it does take a few months to get in your system. All the best

[Hidden in reply to Evie3]

Thank you- glad you got a few years with them. x

[Otto11]

I think I would be tempted to add Sulphasalazine mostly as your Psoriasis is so much improved with it. If it dosnt work then swap Biologics. At least you will know for future. Good luck x

[Hidden in reply to Otto11]

Yes I've just been thinking better trying sulphasalazine, thanks. x

[diana16]

Hi Fuzzy , Like you I suffer with PsA and am on Imraldi and oral steroids which have worked well for me for many years. I still get psoriasis on my legs and have no noticed no difference with the Imraldi but it is the pain and loss of movement that it has helped. I would agree with other comments - have a good chat with your rheumy - I would be inclined to stick with the Imraldi and try adding in the Sulphasalazine. Good luck.

[Hidden in reply to diana16]

Thanks diana16 yes I'll do that. Got dermatology then rheumatology appointments over the next 3 weeks so will try adding sulphasalazine. Got a leaflet last time from the rheumatology consultant and probably just panicked at the idea of more tablets. x

[OneLove2019]

Hey fuzzy, I had to switch from Humira to Remicade to Actemra--in the first two cases due to the fact that I developed antibodies--my immune system is horridly wicked in that regard. Acterma kinda works just not as good as Remicade did in IMHO. I cried when I had to get of it as it was the only thing that had worked thus far. I also take dupixent for skin-related flares. There is no easy solution for this kind of stuff, and acclimating to each new biologic is a process--sometimes you will experience a flare as you adjust. Feel free to ask more in-depth questions about my experience--all I can say is it had been a rollercoaster ride.

[Hidden]

Thanks for that. Yes it is complicated! Much appreciated. Hope you get on ok with your new one shame it is not so effective....yes it is a balancing act. x

[OneLove2019 in reply to Hidden]

Indeed, and let me know how your journey in this regard ends. Best of luck to you!

[Hidden in reply to OneLove2019]

You too 🍀 xx