Starting Systemic Meds – An Anxious Prospect
from Lee Ann

After searching about the web for three months now I finally found your site.

I read about your experience with methotrexate (MTX) when you first took it.

I was recently diagnosed with psoriatic arthritis. I am 53. I have had skin Psoriasis for 25 years. It was all over my elbows and knees for about 10 years. I managed to get my knees and elbows cleared 15 years ago. I have an occasional small plaque or two when I am extremely stressed.

I woke up 4 months ago with a sausage finger ... and then a week later had another ... and now have another one on the other hand and three sausage toes. I am stiff in the morning and have a lot of pain in my knees.

One rheumy wanted to put me on MTX and it scared me. I drank a LOT of alcohol for 30 years. I quit drinking 6 months ago. I am afraid of the liver side effects ... but my PsA is progressing and I need to do something. 

I am currently only on Ibuprofen and it helps a bit with pain. 

I went to another rheumy who wants to jump straight to Prednisone and Enbrel or Humira, depending on what the insurance company will okay. I was just getting myself used to the idea of taking Metho when the new rheumy wants to skip that because I used to drink and go straight to the injectables — which also scare me because they have not been out that long.

I need to make a decision soon, and have myself so scared and confused. I got the psoriasis to clear up on my own but now this arthritis seems to have taken hold inside my body and it's really getting to be a bad situation. 

I have not read your entire site. Just found the Methotrexate Journal about when you finally went on Metho.

Any thoughts, ideas, advice would be more than welcome.

Hope you are doing ok.  Sorry you deal with Psoriasis too. -Lee Ann

*****

Ed's Response: Sorry to hear about your exploding PA, Lee Ann. I can understand your Dr’s reluctance to put you on MTX. I hope I don’t have to use it anymore; however, it always worked fairly well for me (after the rocky start-up) and I even went long enough to require a liver-biopsy to check for damage. It checked out okay, too. However, I have never been better than I have been on Humira. Humira is another biologic like Enbrel. I take twice the recommended dose (under Dr. direction) but it has put my P arthritis (PA) into remission and KEPT IT THERE for the past 4.5 years. I used to have to climb up to my attic office backwards, on my butt, because the PA in my legs was so bad I had to use my arms to raise me step by step. Haven’t even THOUGHT about that for going on 5 years. There were days I was afraid to drive. Haven’t thought about THAT, either.

Please don’t be afraid of the biologics because they are so new. Enbrel and Humira aren’t that new. They were used for YEARS to treat people with rheumatoid arthritis BEFORE they were approved for P/PA. You have to be careful of some things when you use these biologics ... keep your Dr. apprised if you think you’re getting more colds, flu and infections than you used to. And don’t worry about giving yourself the shots. They are easy short-needle shots in the stomach that you do yourself. (Since I’m also diabetic taking insulin, I give these subcutaneous injections to myself several times a day. My grandkids think I’m ever-so-brave!)

There is also a newer biologic, Stelara, which only has to be taken once every 3  months after you take two starter doses in 1 month. That’s on my list of a NEXT THING to try when/if the Humira stops working. (Right now I take a Humira shot once a week; most people take it every OTHER week.) I tried the every OTHER week regimen for six months, but wasn’t getting clear and the PA, though better, was still painful. Years ago, trying Enbrel, I went through the same thing until they doubled THAT dose.  So, if you don’t get the improvement you need in about 3 months, ask your doctor about increasing the dose. I’m sure he’ll want to start you on the prescribed minimum dosage of any biologic.

Please let me know what you decide to do, Lee Ann. MTX is better than nothing, cyclosporine is also a possibility (also capsules you ingest). MTX began to lose its effect with me at higher doses and smaller doses weren’t much good at all.  (I need about 25 mg of MTX weekly for it to be effective.) The cyclo, which is dosed according to how much you weigh, affects kidney function and blood pressure and I can usually take my weight-dose for no longer than 11 months before my blood pressure rises too high and swelling sets into my legs and feet. For these reasons, I was very delighted to find some biologics that worked well for me. Very LIBERATING.

Just concentrate on getting better first; then, if you’re not on what you consider to be an ideal medicine, take your time to decide what next to try.

Looking forward to hearing from you again, -Ed

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