Just for background, PMR since last 2010, later diagnosed as Late Onset Rheumatoid Arthritis with PMR prodome. Started on 15mg pred, and have recently got to 1 1/2 mg plus taking leflunomide alternate 10/20 mg. So all going well in that I am mobile, am still able to go hill walking, and keep to a fitness regime.
I have now been diagnosed with Palmoplantar pustulosis psoriasis, which initially only affected one foot quite badly. I have had light treatment, but this was ineffective. Unfortunately the psoriasis is now affecting my finger nails quite badly. The dermatologist said that methotrexate would be effective for both this and the RA. I’m so reluctant to change meds, as I’ve been doing so well on the leflunomide, however I find the situation with my nails more distressing that anything these autoimmune problems give us.
As well as the above, I’m on thyroxine, the dosage being changed from100mg to 75mg through the week and 100mg at the weekends. I wasn’t sure at first whether I felt okay on this change, but on balance haven’t felt much different.
Then to cap it all, on the last blood test I had, the docs now want to ‘offer’ me cholesterol lowering medication!
I think I’m just offloading really, as I suppose I’ll have to bite the bullet sometime. Dermatology said there were biologicals which would help, but that you had to through all other treatments first before being considered for this.
Thanks for listening.
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Lizzery
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Hi Lizzery, I've been on and off steroids for over 20 years for a number of autoimmune conditions. I was then diagnosed with PMR a few years ago which was treated with Prednisolone, but they could never get the dose quite right as my symptoms were up and down so the number of tablets kept changing. In the end I saw a different Rheumy and he diagnosed Psoriatic Arthritis and said he thought that's what I'd had all along, the PMR was a misdiagnosis. As an aside I've had psoriasis for many years and learned to live with it. It was decided I'd been on steroids for far too long and to switch to MTX provided the liver tests etc were ok, which they were. I've been on MTX (20mg once a week) for over a year now and I think it's great! My pains have all but gone and I'm able to do all the things I couldn't before, the plus side is my psoriasis is hugely improved which I didn't really expect. They would have to fight me to get me off MTX now! On a separate note I've been on maximum dose statins (80mg) for years and it doesn't seem to bother the MTX. I don't know if any of this helps you make a decision but good luck with your condition and meds whichever way you go.
Thank you so much for your reply, it’s very helpful. I’m always very reluctant to start new meds, as we probably all are. When I set out on my steroid journey, my Doctor gave me the prescription, and said it’s up to you when you start these, and once I’d gone ahead, the results were almost miraculous. So once again I’ll have to give myself a talking to and tell myself to ‘just do it’.
I'm glad to be of help. Yes steroids are amazing and the results are super quick but they have their downsides, particularly if taking them for a long time. MTX is a great alternative and in my view a better one, the steroids never did anything to improve my psoriasis. They started me on 70mg pred and I got down to between 5 and 10mg so needed to get off them for lots of reasons. Be brave and grasp the nettle, they call MTX the wonder drug!
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Should I take Leflunomide?
All ok but.......
Nails 
What should I expect?
rheumatologist locum visit for prednisone refill
