psoriatic arthritis

[Beata0102]

Does anyone know what the next drug is if Methotrexate and Sulfasalazine do not work for psoriatic arthritis and psoriasis after three months????

[KittyJ]

No one here can really answer that as it’s up to your rheumy what they try next and they all take different approaches.

[Beata0102 in reply to KittyJ]

Thank you for your answer, I'm just new to this and these medications don't help me at all, I haven't been able to walk without a crutch for three months and it's already worrying me.

[welsh12 in reply to Beata0102]

Hope you find something soon

[KittyJ in reply to Beata0102]

There will be a med out there for you, it can just take time. There’s still a chance mtx and sulpha might kick in for you as it can take 3months or so to work so fingers crossed 🤞🏻

[Retirednhs in reply to KittyJ]

Hello that is correct you need to contact your help desk at your Rheumatology dept and discuss it with the nurse who will speak to the Consultant for you and if necessary they will see you soon don't hesitate to do thiscthey are there to help you out . Good luck

[Madmusiclover]

It depends but the good news is there are many more!

[smilelines]

I know that methotrexate and leflunimide are at about the same level of strength and both Dmards so I think it will be leflunimide. After this then biologics. Maybe they will be able to skip to the biologics but I am not sure of the rules. Here in Canada you have to have tried methotrexate and leflunimide before you can get biologics. There is a risk of psoriasis being spurred on with hydrochloriquin (sp?) and it is a milder Dmard so I doubt you’ll go on that. Hope this helps ease your mind.

[AgedCrone]

I’m afraid although three months does seem forever when you are first diagnosed in RA terms it is not long at all…give Mtx & SSZ more time & get hold of your your rheumy nurse for advice. The only person who can decide what you take now is your rheumatologist.

The good news is that there are plenty more DMards to try…& always tell your rheumy team when your prescribed meds don’t help. If you don’t speak up…it is assumed everything is going well.

I hope you find YOUR MEDS very soon.

[Gilliancheche]

Sorry to say most of the medications take quite a while to work, months rather than weeks. Dosage of Methotrexate can be increased and swapping to injections can work better. I was given COSENTYX in addition to the methotrexate but there are many options and combinations so try not to lose heart. It is a slow process but there is light at the end of the tunnel. X

[rmros]

Three months isn't really long enough to get the full benefit, but you might get a steroid to keep you going.

I was told I was eligible for biologics for PsA because I had failed two DMARDs. Unlike in RA, one of them does not need to be methotrexate (in my case it was hydroxychloroquine and sulfasalazine). If your psoriasis is severe that might work in your favour in terms of qualifying.

The rheumatologist was going to try cyclosporine first but that was ruled out due to high blood pressure, and methotrexate was ruled out due to possibility of getting pregnant. So biologics were the only option left. But this was after three years on conventional DMARDs, not three months.

[oldtimer2]

Treatment changes are much the same as for Rheumatoid Arthritis, have a look at the NRAS website :nras.org.uk/information-sup...

or on the versus Arthritis website :

versusarthritis.org/about-a...

[Aporiac]

A biologic (Hyrimoz) was the next step for me when methotrexate + sulfasalazine didn’t work (substituted for the latter). Assuming a biologic is considered to be worth trying, you’ll probably have to wait a bit because of the expense (at least in my NHS area you have to meet formal criteria, which takes time). I hope things work out soon.

[LinaM]

The third drug they gave me was hydroxychoroquine but it didn’t work for me either unfortunately. It really is just trial and error but if you’re not having any side effects maybe ask the rheumatologist nurse how long you should stay on them before giving up . Good luck ! x

[Orangutans]

Hi. I have had psoriatic arthritis for over 50 years. There are a very large number of alternative medications, including biologics. They can be amazing if you are given one that really suits you. It is just a case of trying them. They don’t all work for everyone so talk to your consultant and get their help and advice. I wish you luck and good health.

[Kariss]

Hi, I was put onto the biologic Benepali for psoriatic arthritis after about eight years on methotrexate because improvement in my condition had slowed down. However you do have to tick certain criteria to qualify for biologics, such as points of inflammation present. This was the second biologic I tried as the first one (Adalimumab) didn’t show improvement for me. All the medications proscribed for RA do take quite a while to take effect as they build up in your system. The clinic should be able to advise you if you need to change. Sadly they are never a quick fix! When mine have taken a long time I have frequently been given a depot steroid injection to keep me going. These work almost straight away and last for six weeks or so giving your new med time to take effect. I hope you get some relief soon.

[Jackie1947 in reply to Kariss]

Benipali is the only med that put my RA into remission

[MagsLough]

l am on methotrexate and benepali for psoriatic arthritis but it was a long time before I got the biologic after persevering with mtx as it can take a long time to really notice improvement.

Speak to your team about what they would be thinking time wise re your current meds.

[Beata0102 in reply to MagsLough]

Thank you for your answer. How long did you have to take methotrexate and other drugs before biologics.

[MagsLough]

It was easily 18 months, but in my case mtx was working for a while and then I started to go backwards a bit which can happen.

Don’t take that as being what will happen in your case as we’re all different with different degrees of inflammation and different reactions/tolerances to the wide range of drugs.

I’m pretty sure your rheumy will be able to outline a plan at least in broad terms that might help you.

[Beata0102 in reply to MagsLough]

Thank you for your answer. My problem is that I have not been able to walk for 3 months, only with a crutch, because for 3 months I have had inflammation in my entire ankle. Since I started taking methotrexate, my skin has gotten worse because I also have psoriasis, but I still have to wait 4 weeks for an appointment with a dermatologist and a rheumatologist nurse and I don't know what will happen next because I'm new to it. Thank you very much for your answer

[MagsLough]

you’re very welcome. It’s daunting and unfortunately it takes time. But I am sure you will get there in the long run. Good luck

[Beata0102 in reply to MagsLough]

Thank you

[Louise0000]

Next step is a biologic humira

[Beata0102 in reply to Louise0000]

Thank you for your answer. Do you now how long I have to be on Methotrexate + sulfasalazine before next medication????

[Louise0000 in reply to Beata0102]

My consultant stopped methotrexate due to it causing high liver function less than three months in. Was immediately started on humira biologic which was amazing but stopped working for me. I am currently on benepali and seems to be helping.

[Beata0102 in reply to Louise0000]

Thank you very much

[Louise0000 in reply to Beata0102]

No problem at all I wish you the best of luck in your journey