Between two biologics

I am between two biologics right now waiting for it to kick in. But theoretically it could be starting to work with the PSA but not touching the OA because it is a different situation. so my question is how does one know it is starting to work when you have both.

Are you sure you have OA? Could it not be PsA damage instead? Both look precisely the same on an xray so depending on your age and whether you were an elite athlete or not the likelihood is that if you have PsA you get PsA damage and OA.

That can get confused as we age as of course older people will get OA since it’s an essentially a wear and tear issue. But it will tend to be limited to a say a hip or a knee and not the widespread damage PsA can cause us sufferers.

No biologic can fix damage whether it’s caused by PsA or OA. It can merely help to slow down new damage caused by PsA.

So the pain from damage is one thing and the pain from inflammation is another. We tend to know a biologic is working when the inflammation pain often like a internal burning sensation and the tendon pain recedes.

Do remember that no biologic reaches full efficacy until the 12 month mark and many of them don’t tend to kick in so that you notice until around the 6 month mark or later.

thank you
i have been told i have OA in one knee and PSA on the other for i had a bike accident and got hit by a car. i was just curious on how one knows in general. i am 57 and have been active all of my life but with this disease i have had to slow down.
thanks for the response it helps.

In oa perhaps the pain in steady rather than comming and going over a period of time .

Do you have PsA damage in one knee and OA damage in the other knee? Or do you just have PsA inflammation in one knee? The point of what I’m trying to say is that given PsA damage and OA damage looks so similar why are they saying you have OA given your PsA diagnosis?

It’s highly likely your OA is from PsA not OA just anyway given you have PsA.

In PsA damage the pain is prescisely like OA because just like OA PsA has eroded the joint.
PsA inflammation is of course a different thing entirely.
Is it the case in the USA that they just label all PsA joint damage OA erroneously and have completely forgotten PsA causes joint damage too?

i just remember the left knee every doctor kept on saying for ages of this OA from the car accident. the other body parts are all psa. when i have been for other parts they keep on saying it is from PsA. so who knows!

My experience has certainly been that assumptions are quickly made that most joint pain must be OA…and based on age not xrays.

i am just trying to
figure out the difference myself so I know if the biologic is working or not since i am starting a new one. i told my husband i am not going back to ortho unless i am going to have surgery for they just say it is arthritis and have me come back in two weeks knowing that in two weeks it will not improve.

i have all the braces i need!

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A concerted effort needs to be made to educate and remind your attending doctors that PsA does of course cause damage too. And therefore it would be most welcome if those very expensively educated brains actually engaged with the rationality of that. As frankly it’s not that hard to know PsA causes damage since it’s the sole reason all these scary and expensive meds were developed which those same doctors want us to take.

exactly. there are times that i feel i know more than ortho. do currently trying to just educate myself on the ins and outs of this condition

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I’m confused because biologics don’t do anything for OA??? I hope you don’t have a doctor that is telling you they do. A biologic can slow down PSA doing more damage and causing the OA to get worse, but that is it.

I am not sure where the data came from saying no biologic is fully effective until 12 months? That may be true if the biologic is “being” affective. If it is not working, waiting 12 months is not going to help.

Damage from PSA may as well be labeled OA. It is just not OA that caused the damage, but at that point it is essentially OA. Both of my knees now have OA. Whether it was PSA damage or slow OA, it is still OA.

no ortho has ever told me that bio helps PsA. I am just trying to figure out the difference between pain or discomfort level one has how can one distinguish between the two.

There are acres of data on biologics not reaching full efficiacy for a year. Certainly it’s the ethos of the British Rheumatology Association.

My present biologic didn’t kick in until the end of month 8 and then gave me 4 glorious years of very little PsA symptoms. For other people that same biologic didn’t kick in until month 10 and for a close friend it was month 12 and she got 8 years out of it only just recently changing biologics. If we had all stuck to the three or four months notion of a biologic needing to work, look at the years of controlled disease activity we would have missed out on? It’s bonkers to miss that chance in my view and it’s bonkers to miss that chance in the view of my specialist PsA rheumy too. And I’m really grateful for her insistence and specialist knowledge on this too.

When the damage caused by PsA gets labelled as ‘just OA’ it negates the cause of why the damage happened. So that in turn permits the medics to downplay the seriousness of the PsA disease activity wrongly and then not seeking to seek to ‘treat the patient to target aggressively’ (as per GRAPPA guidelines GRAPPA meaning Group for Research and Assessment of Psoriasis and Psoriatic Arthritis) leaving the patient under medicated and under cared for.

If the damage gets labelled as being caused by PsA disease activity instead, then it’s much clearer that the PsA disease is not under sufficient control and so the medics work harder to get it under control.

Also to the trained in PsA damage eye there are subtle differences in how the joint damage presents along with more complicating factures if seeking to replace that joint too. Blindly bashing in and deciding it’s all just OA leads to much poorer outcomes on joint replacement in PsA patients which is unnecessary so that’s why it’s so important to label the damage correctly. And it’s even more important the orthopaedic surgeon has some PsA expertise too.

My point being if I have to wait 12 months to see if the latest biologic is going to work, I may as well not be taking anything. Having to suffer for 12 more months before a doctor decides it is working or not is unacceptable. If it isn’t working do i go another 12 months on something else, then another 12 months and on and on…

There may be a ton of “articles” showing it kicks in after 12 months, but who can say the PSA just didn’t change after 8 or 12 months?

This is a similar nonsensical result (in my opinion) advertised with a drug saying 60% of patients saw a 20% improvement. That is a useless response to justify the drig being approved by the FDA. It is like the useless approval threshold for a new antidepressant being 35% affective to be approved by the FDA. Placebo will show a 35% improvement in the treatment of depression!! So Tic Tacs may as well be approved to treat depression by the FDAs logic. May 12 months of waiting on a biologic could be placebo.

Since there is no reliable marker to test if a drug is actually working or not, a 12 month respone would be anecdotal to me. Someone counting how many of my joints hurt as a reliable response measure is not reassuring. Over 12 months if i was not on any meds i am guessing between flares and just normal cycling of pain and symptoms, how can anyone reliably say X finally kicked in???

To me and my doctor if it is not helping any better than the previous med, we change. ESPECIALLY after 12 months.

I change too if it’s not helping or throwing up side effects. Enbrel worked between month 6 and then abruptly stopped at month 9 so was ditched at month 11. Humira hated me and was ditched after 8 short weeks. But because I did well in the loading doses of Cosentyx I was told to wait. And I’m glad I did because it worked so unbelievably well for me. I went from barely walking the length of my garden to being able to climb a mountain all within one short year. My point is I would have lost that chance of capacity had I ditched Cosentyx at month 4 or even month 6.

Biologics (unlike JAKs) don’t work fast and aren’t designed to work instantly either. JAKs are but still people say it takes a heck of lot longer than the 21 days to feel the effects as our @Amos wrote about.

For some reason other than the initial trials to get meds approved for use, sadly there is a huge lack of research after that to track how patients actually do respond to the meds, (unless there are dangerous side effects) so data as to when a med might work ends up being anecdotal. And frankly if you have enough people feeding back on that (I belong to another group of 6,000 PsA patients mainly in the UK) then you start getting more a realistic idea how the meds work or don’t work. Which is far more useful at the silly adverts giving weird percentages. Thankfully in the UK we don’t permit adverts of meds like this.