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Living with Psoriatic Arthritis (PsA)

Any alternative to steroid injections?

Hi, I’ve got a really sore wrist again, which has also been swollen for about a year. Last summer i had a steroid injection in the joint, which didn’t help the swelling (which is actually around the distal radius/ulnar rather than the classic wrist area), but really helped the pain for about 4 months.
However, it also made me manic, and not in a nice way. For about a week i was waking really early, head just buzzing with stuff, for the next month i was combatative, bouncing around like Tigger, my husband described me as “Andrea plus”!! People at work noticed, i had to apologise to my boss at one point for a very challenging email i sent her! I also have ectopic heart beats which were more frequent.
I’m really sensitive to stimulants - i can’t drink caffeine at all, or even ginseng.
So, basically, my question is this - has anyone tried anything that’s as effective as a steroid injection but not a stimulant? I was wondering about acupuncture? I’ve heard about CBD salve, any good for this?
Would be most grateful for some advice - ibuprofen gel just isn’t doing it for me :heart_decoration:
Thanks, Andrea x

Hi a.laker28.

First thing I’m thinking is a re-think of PsA meds … what does your rheumy say about your wrist?

Only other relief-measure I can think of is a wrist support of some kind. But if the joint is swollen, I’d have thought something needs to be done to reduce inflammation in addition to pain relief.

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Yes I’d be looking at rheumy to explain why my wrist was so bad too. The classic non-steroid steroid is hot/cold etc and/or RICE in physio terms. Have you had an even an x-ray of your wrist - does it show anything? I assume the rest of you is liking Humira that is the one you’re on now isn’t it? You and Benepali didn’t mix well if I remember as we both started it at the same time? Also how does your wrist do if you wrap it in ice for a while? Or wrap it in heat for while? Is one better than the other? Do thing improve with either, or both?

As far as I’m aware mostly the only thing you’ll be offered is another steroid shot which is obviously a no no. Was the previous one ‘guided’ though, rather than ‘guess the spot’?

I don’t know what else to suggest other than if I was in your situation I’d really want to know what physiologically is precisely going on with my wrist. I’d want x-rays, scans and an MRI on it so as to know why just it is swollen and painful, instead of various other bits of me too. You could have the dreaded OA in it though. However I’d want to know all that.

This will make you smile. For my birthday in January, my sister sent me a huge cheese hamper! :rofl: I’m still plodding my way through it slowly. If we lived closer I’d have invited you over to help me eat some of it.:joy:

I live on a prescription salve called Voltaren for my wrist and fingers and a Patch called Flector for my T-Spine. It gets the NSAIDS where they need to be…

I’m glad to hear you are looking at alternatives to steroid injections. They are becoming common - TOO common. Yes in some specific circumstances they can provide a lot of relief. BUT they shouldn’t be used with out a pretty extensive imaging workup (plain old x-rays are the best.) you need to eliminate any actual physical damage or they wont work.

The finding you want (For injections to work best ) is: “narrowing of cartilage” which indicates pain may be more inflammatory than mechanical. As that narrowing progresses bone spurs etc start to form which leads to surgeons etc.

The problem with steroid injections though is after a while they tend to soften up cartilage speeding up the problem. A few is no problem but if it becomes a habit it is a problem.

I just started injections (this morning in fact) for my knees. Progression isn’t an issue because new knees (and hips) are on the horizon (love my new shoulders) anyway. You can replace knees hips, shoulders,and soon ankles (yeah they do ankles now but its really not ready for prime time IMO) Wrists thumbs etc, you have to live with.

Try the topicals first. Be careful of splinting, don’t buy them in the drug store. While they provide relief they ultimatley result in loss of function. Your doc is a good resource. PTs usually won’t touch them (But the despite PTs cheerful smiles they really ARE Masochists at heart) My favorit FWIW is a real blast from the past - hot Parafin baths (good for the P too)

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Thanks everyone for your responses. I have fairly recently had x rays including my wrist and apparently nothing to note there :dizzy_face:
My PsA definitely isn’t under control on the Humira, sadly no change at all. I saw my rheumy yesterday who wants me to change to a new family of meds (Humira and Benepali both anti TNF family?) and has suggested a newly approved drug Xeljanz (tofacitinib citrate) - anyone heard of it/trying it? Tablets this time, twice a day. Although my PsA is not the worst by far (though the worst it’s been for me), my rheumy was sympathetic to my desire to prevent joint damage and keep me working and active. So hopefully will be changing to this in the next couple of months.
I have a prescribed splint for my wrist, which does help, but is not a long term answer due to potential muscle wasting, as you say tntlamb. Easing off the piano practice also helps too, though moderate amounts of practice helps my dexterity and I’m determined to crack the new Adele piece I’m learning!
I wondered whether acupuncture might help?
My rheumy felt that the only thing would be an injection and if my wrist was bad enough I would put up with the side effects - medics aren’t well known for their holistic views! Though to be fair, if it gets much worse, i might just do that!
Poo - love the cheese gift, tempted to get on the train right now! My rheumy would be horrified to know I’ve recently been enjoying porridge made with raw buffalo milk!! The creamiest thing you could ever taste! Le Rustique camembert my current cheese favourite :stuck_out_tongue:

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Oh and @tntlamb, when i was training to be an OT I remember using hot wax baths for RA, guess that must have been what you meant. Not heard of it for a while, might look into that.

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They are lovely!!! Definitely still available & recommended. The hand OT got me to try one … should have put it on my Xmas list really …

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In fact, here’s just the thing, bit pricy though http://www.therabathpro.com/about_paraffin_new.php

Oh my days, you can put your elbows in it … of course! I want one now.

There’s some cheaper ones on Amazon…! I’m very tempted :grinning:

Speaking as a licensed acupuncturist with PsA I strongly suggest you seek out acupuncture for your wrist. Please feel free to ask me any questions - it will not “cure” you but if you go to a skilled practitioner it is likely to help. If you are comfortable sharing your location I would be happy to look for someone to refer, but if not I understand. I cannot recommend this highly enough in your specific case - assuming you are not on any blood thinners that I don’t know about.

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Hi, I’m in Glastonbury in Somerset (UK), would love you to recommend someone if you could? I’m not on any blood thinners. I would just reiterate that I cannot tolerate any stimulants - in fact the last time I had acupuncture (on my foot for plantar fasciitis) i ended up in hospital because my heart went into AF several hours later, though I’d also had 3 caffeinated drinks that day, so was hopefully more that.

I’d just like to try a drug-free option. Thanks

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Someone one here has journaled her journey on xeljanz - really interesting. So check it out. So glad your rheumy is doing his stuff bar another steroid injection which might of course give you ‘roid rage’ again. My mother had COPD and eventually we had to ban her been given steroids of any sort. However for me they turn me into positive Pollyanna, which is also irritating to live with but at least less aggressive. But very busy.

I’m liking the paraffin bath notion. And my grandfather swore by acupuncture (not for anything specific) he just loved it and possibly the pretty Chinese lady who administered it too. That was somewhat progressive for an army man born in 1898, I always thought. And in Ireland too.

Years ago I wanted to be a cheese farmer and merrily daydreamed of getting some buffalo to milk in addition to cows, goats and sheep. And now we have a cheese maker on here too from Ireland. If I’m not mistaken he might be taking the same drug too that you’re about to take, or it could be costenyx, I’m not sure. However you can keep all the porridge to yourself, I prefer my oats dry. Porridge reminds me of semolina and tapioca both to be severely avoided at all costs in my view.:hugs:

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Just had a read of the Xeljanz journey, feeling quite positive about it. Nice to hear some good results.
Just spent some time in the garden moving some rose bushes in bright sunshine in a t-shirt - in England, in February!!! What could be better?
I’ve rediscovered my compression gloves, gonna try those and see if it helps my wrist, but definitely want to try acupuncture. I definitely think hot/cold helps too, gonna get some more tigers balm which kind of replicates that.
You should try buffalo milk, it’s lush!

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How the hell do you milk a buffalo. They are some fearsome creaturesBison-charging-towards-photographer-568942

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Ah - sadly I do not think I can be helpful. I am in the US and the laws and standards are so different, and I don’t have any professional connections in the area.

And yes, it is far more likely that the AF was due to the caffeine as opposed to the acupuncture. In fact acupuncture has been shown to regulate the ANS, often through stimulation of the parasympathetic nervous system. This is believed to be one of the mechanisms of action from a modern scientific point of view, and why acupuncture makes most people sleepy and happy.

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dfd7d2a6167ba4b55048a4b08cd12fde
Water buffalos - slightly friendlier!

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We Brits are always milking buffalos, it takes our minds off Brexit. Glastonbury is a buffalo hotspot. It also has a notable Tor.

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Hmm, that’s interesting about the sleepy and happy - I had a PT try it once and the referred pain and nausea were intense (I nearly vomited on him), but worst was the sense of overwhelming fear. I have never tried it again I must admit.

I have tried many alternatives, including acupuncture, chiropractor and massage. These are awesome helpers with your medications. The most important thing to remember when on Biologics is avoiding any kind of infection…sanity, sanity and sanity again. I watched my acupuncturist take each needle out of a sanity bag the first couple of times. It is also important to be able to relax, so you need to be able to trust your caregivers. I call the shots with every one of my caregivers. This is my disease, this is my health, and I can’t control the disease, but I can control my treatment. I research everything. My chiropractor refuses to touch my wrists. She says she knows they are inflamed, she knows they hurt, but adjusting them will not help…this makes me trust her even more. My acupuncturist absolutely refused to deal with my neck at last appt…he said I have some serious issues going on even though I thought it was my shoulder…after MRI, he was correct.

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