I saw my rheumy on Thursday for the appt I've been waiting for: a prescription for Enbrel. What he said instead is he wants to inject all the sore areas with cortisone shots under sonogram guidance. This dr. makes over $800. per visit to use the sonogram machine in his office. Insurance pays the charge. I pay in pain and inability to walk or use the joint for a few days due to pain, not to mention the pain of the shot at the time it's given. Dr. doesn't think my PsA is quite bad enough to warrant a biologic even though he's been talking about using one from my first visit. So what do ya'll think about this? I have pain in my toes, ankles, elbow, wrists, hands, fingers and neck and back.
Is he talking about doing this AND a biologic or instead of a biologic? The PsA needs to be slowed down or damage will continue / get worse. The cortisone shots, if I understand correctly, may give you relief, but not treat the disease. Are you on mtx or anything else to treat the PsA? If not, I'd say he may be doing it for the money. If so, it's difficult to tell.
Doing the shots instead of a biologic. The way I figure it, and I may be wrong, is if he gives me rx for Embrel, Embrel makes the money. If he gives steroid injections he makes the money. I had a good day when I saw him, but today if awful.
My doctor injected with knee with steroid and put me on Enbrel. Steroid injections really do help, but they don't last.
I would reject it. Tell him that you want the progress of the condition slowed down before you have any more joint damage. you may be dropped but it doesn't sound like your doctor has your best interest in mind.
Steroid injections bring relief for a month at most. I've heard that cortisone never leaves the body. Anyone knowledgeable on this? Shutterbug, thanks for validating my gut feeling.
Andrew said:
My doctor injected with knee with steroid and put me on Enbrel. Steroid injections really do help, but they don't last.
Will your insurance cover Enbrel now?
Yes, Andrew. I would pay a $30. copay per month. With the coupons from Embrel, that amt. would be even less. I pay $40. every visit with the rheumy.
No reason that I know of that you can't do both, but I am not a Dr. I do agree with nym that you need something to slow the progression, this Dr is allowing more damage to occur, which is unforgivable! Speak up, you have to be your own advocate!
From what I can hear, the issue is not really whether the motive is conflict of interest, but that even with my limited medical knowledge (and obviously yours too - otherwise you wouldn’t be asking the question), he’s not giving you the best treatment.
Biggest priority for you is to get the treatment you deserve, then worry about those with less than honorable ethnics once you have everything on track!
You are right on, JenAus. Thank you.
The dr. told me that if I demanded the Enbrel he would prescribe it, but I don't want to have to demand something. He tells me that he has years of experience, and that he's better at knowing what's better than some young, just out of school young dr. I do appreciate experience, but I felt wrong getting a 2nd opinion after that.
SK said:
No reason that I know of that you can't do both, but I am not a Dr. I do agree with nym that you need something to slow the progression, this Dr is allowing more damage to occur, which is unforgivable! Speak up, you have to be your own advocate!
Bad attitude on his part. And some young, just out of school doctor may be much more up on current treatments than this doctor, to look at the flip side of the coin.
I found that cortisone shots never helped my arthritis pain one bit. And they're only a temporary fix at best. You deserve to get long term help not just a temporary fix. Especially since PSA is known to be a fast moving and destructive illness. If I were you, I'd do the demanding now, before your body is too crippled or deformed to do it later.
michelle said:
The dr. told me that if I demanded the Enbrel he would prescribe it, but I don't want to have to demand something. He tells me that he has years of experience, and that he's better at knowing what's better than some young, just out of school young dr. I do appreciate experience, but I felt wrong getting a 2nd opinion after that.
SK said:No reason that I know of that you can't do both, but I am not a Dr. I do agree with nym that you need something to slow the progression, this Dr is allowing more damage to occur, which is unforgivable! Speak up, you have to be your own advocate!
The rheumatologists in the UK put out a standard of treatment. http://www.sign.ac.uk/pdf/sign121.pdf
You can look at psoriasis.org for treatments used in the US.
The only thing I can think of is that your doctor thinks the steroid might calm the the disease down and keep it calmed down. Maybe that works sometimes in cases of mild PsA? Steroids don't seem to work that way though. They last for a month and that's that.
If you have psoriasis also, I think that could make the decision. I mean wouldn't it be nice to take care of both at the same time?
I don't think it's a conflict of interest, the doctor is making a judgement call. He must have seen people with your condition respond well to his cortizone shots. I just so hesitate to give advice though! I'm not a doctor and even if I was, I haven't examined you! Can you get a second opinion??
I'll say three things though:
1. Enbel for me has been awesome.
2. One round of steroid shots probably won't hurt you and if they don't work you can go on Enbrel.
3. Don't take too long to make a decision.
My rheumy is a relatively young woman who came from UCLA, which is probably on of the best med schools on the west coast. Anyway, she has told me from the very beginning that steroids may make you feel better for a short period of time, but that research has found that use of steroids actually make the psoriasis flare up worse than before you used the steroids. For that reason, I've never been given steroids. My psoriasis is BAD....even with MX and Enbrel, I still have joint pain (although less than before) and psoriasis that doesn't completely clear up. And, right now, she has me off of the Methotrexate because my Liver tests came out elevated in my last bloodwork. I think you need to find a new rheumatologist; you do need to be your own advocate and in the long-run, YOU have to live with your body, not your rheumy. Don't let things get so out of hand and so damaged that you can't live a productive life. Good luck with everything.
Okay, my first question is, how often are you getting the cortisone injections? Cortisone can lower your immune system same as biologics. Then second, why is he using u/s guided injections if your pa isn't bad enough to warrant biologics? I know this may seem odd, but please tell me that he is also using a different syringe for each site injection and not reusing the same one over and over again.
I think it's a conflict of interest. According to my rheumy the standard practice is cortisone shots if under 3 joints are involved. Anything over 3 joints should seek alternative treatment. It looks like he's trying to treat you in a method that isn't in your best interest.
If he gave you grief about getting a second opinion - to me it’s a clear sign you need one AND a new doctor! Jerk. Also if he said he’d prescribe the biologic if you demand it - that also means he knows it’s safe for you - otherwise he wouldn’t accept the liability. Still if it’s at all feasible - get a new doc 
The vast majority lf people with PsA are treated with nothing more than some pretty good NSAIDS, and generally with pretty good sucess. Biologics are for when inflamation isn't controlled any other way. Biologics are least effective on peripheral pain. Not sure what the question is......
We have a doc who wants to start treatment by getting rid of pain the quickest way possible as soon as possible before determing the next steps in long term treatment.
I don't know the results of your tests or physical exam and how they fit into his experience. I refuse to get into the young doc old doc debate. Herese the thing you have a doc who wants to aggresivley attack your pain NOW as opposed to "take these pills twice a day" and call me in three months. I know folks who would be giving this guy their first born child.
Are you sure you are clear on what his LONG TERM plan is as opposed to a short term plan? They may be different.
My rheumy believes I have PsA in my body and spine. I've been on mtx for over 6 yrs for severe psoriasis. This onset of PsA occured when I inadvertantly stopped taking it for 5-6 weeks unknowingly. Once I resumed it, the pain got better, but never went away. I also have plantar fasciitis that's been unresponsive to every therapy I"ve ever read about. This guy told me to see a podiatrist. I told him I've seen all of them. He reiterated "see a podiatrist" I've seen chiropractors, masseuses, physical therapists and 3 foot dr.s all for my feet. Shots, crutches, different shoes, different orthotics,no exercise, frozen water bottles, you name it, I"ve done it. My history w/cortisone shots is that the relief doesn't last long. I told him this. He insisted on doing the shots with his ultrasound machine b/cause they work so much better. The shots were 2 days apart, left thumb, right heel. Both still hurt. Dr. doesn't think I am bad enough off to warrant Enbrel. He thinks I should look worse, the joints should look worse. This is where I have no expertise or experience. I hate starting all over with a new dr., but if I need to I will. Just sad and confused right now.