Psoriatic Arthritis Pain Relief

[Soreknees2016]

Hello - I'm a newbie to this forum and wondering if anyone out there suffers from Psoriatic Arthritis? I have had this condition for 10 years, but never yet found anything that helps the pain, having tried NSAID's and co-codamol/solpadol without success. Have agreed with Rheumatologist not to go down the road of DMARDs due to their side effects and immuno-suppressant qualities as it only flares up about once a year. However, I have spent this week in total agony in both knees and one ankle and basically going out of mind with the pain and the constant brain fog caused by solpadol. Seeing GP tomorrow and want to ask about alternative pain relief, and would really appreciate any suggestions. Thank you.

[earthwitch]

You might want to get a second opinion about how to manage the PsA - if your pain is coming from that, then no amount of pain relief is really going to get at the root cause. There are other meds (including biologics) that have far less side effects than DMARDS (which don't usually do a lot for spondyloarthritis anyway) and far more effective.

Failing that, if what your GP is prescribing isn't really doing the trick, then you could also ask to see a pain management specialist and see what they suggest. Bear in mind though that pain management is just that - they deal with the pain symptoms, not the disease that is causing the pain. They do however often have other things up their sleeves beside just meds that can help with pain relief.

The other thing (that I hesitate somewhat to mention) is if your flares really are only very short lived, then a short course of steroids might give significant relief. The reason I hesitate is that steroids should never be used long term or really relied on for inflammatory arthritis of any kind as they are not the most appropriate disease management medication and have far too many side effects - with the risk increasing the more you take and the more often you need to take them. Its not so much a case of whether you will experience the negative effects of steroids (osteoporosis, triggering diabetes, adrenal insufficiency, as well as the usual weight gain, mood stuff, etc), but when, as permanent damage from steroids is almost inevitable if you take them enough. The reason I mention steroids at all is that they can be a miracle to knock a troublesome flare if you expect it to be fairly short lived.

Check out the spondylitis society of america forum (for ankylosing spondylitis) - there are a lot of folk with PsA on that, including many from outside the US, and I am sure you will get a lot more relevant advice.

[earthwitch in reply to earthwitch]

Meant to say that I have ankylosing spondylitis, which is in the same family of inflammatory arthritis (spondyloarthritis) as PsA.

[Soreknees2016 in reply to earthwitch]

Thank you so much for your detailed reply - much appreciated.

Up until now, I haven't really tried to discuss alternative pain relief with my GP, partly because flare ups happen on such an irregular basis, but also because I generally feel that they just routinely prescribe co-codamol and solpadol and don't engage in discussion about alternatives, and I have pretty much accepted that (until now!).

Also, I think there's an element of falling between two stools where the hospital rheumatology consultant deals with the longer term management of the condition, while the GP deals with the day to day prescribing of pain relief, and neither really seems to have a complete overview. Either way, I'm not sure that either of them really appreciates how excruciatingly painful PsA can be

I definitely think that seeking referral to a pain management specialist might be the way to go, as there MUST be something available that can control this dreadful pain, so thanks for that suggestion. In the short term though I have noted that alternative NSAIDs exist (COX 2 inhibitors) so I am also my planning to ask about them.

One positive is that my usual GP recently retired and I think the one I am seeing now is more amenable to discussing options.

With regard to longer term disease management, my rheumatologist (who I find to be very open and prepared to listen and discuss) has perhaps surprisingly never mentioned biologics or courses of steroids, although I have had a couple of one-off intramuscular steroid injections which seem to have been quite effective. Unfortunately I can only have one injection a year, and I've already had one this year. I will mention these treatments at my next appointment.

Thanks also for pointing me in the direction of the SAA forum - I will certainly spend a bit of time reading through that.

[Ginsing]

Hello I do not have psoriatic arthritis as far as I know however my son does. He has terrible problems with hands and back both the psoriasis and arthritis have reeked havoc with his body. He goes to see a specialist at the hospital a rhumutologist he is on injections and they work brilliantly they have given him his life back! So see if you doctor would refer you to the Hospital .

Good luck keep going till you find the right course of pain killer

xGins