I was dx by my first rheumatologist in 2013 with PsA based on clinical exam and nail dystrophy. I have been on Remicaid, Stelara, Orencia, Humira and currently Enbrel and Methotrexate. This has been the best combo so far and I’ve been on it for about 2 years. Recently I am experiencing flares of what appears to be inverse psoriasis in my groin and natal cleft. It almost looks like sunburn.
Since I have not had a lot of skin symptoms, other than my nails, I am wondering if the Enbrel is loosing traction. I also have some new problems with my hands and the PIP joint of my right middle finger. It is really painful, but maybe it’s OA?
Anywho, I was just wondering if you can tell a biologic has petered out if you are having your first major flare of psoriasis while on it.
Hi mimiB,
I’ve been on Enbrel for 3-1/2 years now and it seemed to work best at first. BUT, I do think it’s still working despite my bad feet and bad psoriasis on my right leg.
I know that at least 80% of my really bad PsA symptoms and about 70% of my psoriasis are under control with Enbrel.
Trouble is, you might have damage to your joint in your middle finger, and like you said, maybe it’s OA?
Often I wonder if Enbrel is starting to peter out on me, but then I remind myself how crappy I felt 3-1/2 years ago just before I took my first injection and I KNOW I’m way better off now.
It’s so hard deciding what to do…you sure don’t want the pain to get worse and attack more joints and do damage, but you said Enbrel and Mtx have been working well for you for two years and it sounds like several other biologics weren’t as effective. Good luck–I hope your finger feels better!
Thank you! I do feel much better, in some ways, since the Enbrel but these new symptoms are a bit troubling. It looks like I have mild dactylitis in that one finger and the psoriasis around my nether regions is…well…not much fun.
It’s good to hear your experience. It is sad that we continue to have persistent psoriasis and new joints affected even though our medicine might still be working.
My husband and I had a rheumatologist we really liked and now she’s leaving the practice to work with a group that doesn’t take our insurance. So we will have a new doc in three months. Perhaps she will have a clue as to what’s going on.
Hi mimiB. I’d be wondering the same thing though I suppose the bottom line is that psoriasis can come and go without rhyme or reason.
Last time my P flared it was due to stopping Mtx, it affected at least 50% of my body I guess but disappeared rapidly once I re-started Mtx 9 months later. You haven’t stopped any other drugs you’ve taken regularly have you? I have heard that even stopping smoking can sometimes trigger psoriasis, though not sure how true that is.
I used to have inverse psoriasis, as you say, just like sunburn. I don’t suppose I was stressed to high heaven all the time during the couple of decades it lasted, but even though it had been constant all that time, it disappeared completely when a major source of stress / unhappiness was finally resolved. Could have been coincidence but I think not.
If it’s dactylitis you have then you have to question the efficacy of the biologic, or I would anyway if it lasted and / or more joints started swelling.
Interesting about the stress issue exacerbating psoriasis. I’ve definitely had some of that lately! I have not changed any meds other than tapering off hydrocodone and adding CBD oil.;. Hope it’s not the CBD oil because it helps with pain and stress!
Hey mimi! It’s always nice to “see” you. Funny thing is, I’m having my first skin symptoms in … forever. I’ve never had any significant skin manifestations, only a little elbow patch, and some inverse where the sun don’t shine, but other than that all I’ve had is nail issues, and that cleared with my first biologic.
Now I’ve got some scales and spots on my forehead. I went to the derm a couple of weeks ago, and he said it wasn’t necessarily the Humira fading. I asked if maybe I should inject a bit more often, but he said it was a better idea to just use a topical. Then he took the liquid nitrogen to the scales on my forehead, which was fine except that I was on my way to Las Vegas to meet our own tntlamb and Big Ben himself. Sure enough, the scabs came out just in time for the group picture. Ugh, can you believe it? Oh well … I guess I could just look at that as being strangely appropriate. LOL
You’re liking the CBD oil? Tell.
Oh, my! I bet that was a wild time!
The CBD oil is high potency from Lazarus Naturals. I use 25 mg once or twice a day, sublingually. I hold it there about a minute and then I swallow it.
It really does seem to help with pain and anxiety.
Hi there mimiB 
I have no experience with Enbrel, so unfortunately am no help there… however I do have experience with inverse psoriasis that you might find helpful. Oh, yes… inverse does look a lot like sunburn… smooth, shiny, and red with a definite edge.
My GP gave me an topical treatment called Micreme… it is a combination of 1% hydrocortisone and 2% miconazole nitrate (an anti-fungal), I found it works a treat. I’m also on Mtx which has reduced the psoriasis to almost zilch, but when I do get a small flare of the inverse in my belly crease one smear of the Micreme sorts it out pronto (keep in mind that inverse psoriasis is prone to fungal infection too).
As far as the Enbrel goes, I’d only be guessing to suggest that maybe it is possible to have to “break through flares” of joint symptoms despite the medication working well for you most of the time… it may not mean the medication is failing… just my thoughts, which could be way off base.
I’d definitely be bringing it to your rheumy’s attention, if it is a long wait before you see a rheumy again perhaps you could phone and let them know what’s going on, or your GP might have some insight on it too. It never hurts to ask.
All the best, I do hope it is a short lived issue for you!!
The CBD oil sounds interesting too… do keep us up to date with how you are going on it!!
Cheers!! and all the best for 2018!!!
Thank you! I will ask about the Micreme. Happy New Year!
That’s when I broke out with psoriasis for the first time–when I stopped smoking cold turkey. I never regretted stopping but often wonder if I had kept smoking would I never have had psoriasis? My brothers and sister all kept smoking and they didn’t get psoriasis!
OMG that is the worst–if you’re talking about the butt crack. I’d get it about e/o month and washing there was extremely painful! I haven’t had that since going on Enbrel and hope it never happens again!
I think smoking suppresses your immune system… I dont think it’s the best way to prevent psoriasis though
Interesting conversation here re: stopping smoking potentially causing psoriasis…
Most of what I read says smoking can increase the risk of getting psoriasis, not surprising in the sense that these days smoking seems to get the blame for just about everything 
My sister and I have both smoked since quite young and both have psoriasis, although not what I would call severe, and I’m pretty sure she has PsA too, she has only just started mentioning her joint issues to her doc, so will be interesting to see how that goes.
Perhaps the stress on the body during withdrawal from nicotine might be a reason for psoriasis flaring around the same time as giving up smoking… I have no idea really.
I would never suggest anyone take up smoking as a “treatment” for psoriasis or PsA lol And there is no way that little addict that lives inside me needs any further excuses to not give it up However I have often wondered at the quality of the science behind the current anti smoking campaign’s intensity too.
Mostly when a doc says “xxx is caused by smoking” my response has been “and what do you tell the non-smokers who get this?”… ermmm… that often leaves them a bit flummoxed
Lol! It’s pretty much impossible for anyone who’s over 20 to not have been exposed to a lot of second hand smoking though… And it’s “increases the risk” mostly… not “causes”
Yes, in recent years the wording has been “softened” some to say “increases risk” rather than “causes”… I have also noticed a significant shift in the way doctors approach the subject too, perhaps purely to not get our “backs up” lol
And yes, many will have been exposed to second-hand smoke too… I know I certainly was raised around it.
I will not get into a discussion about the potential pros or cons of tobacco use… and as I say would not encourage anyone to take it up… and do think it’s a good thing that smokers have been forced to be more aware of non-smokers right to clean air It seems, at times, as if it has all gone a bit too far though.
Each to their own 
Smokers will actually get mad at me if I cough from smoke and then think they are completely in the right and I must be pretending… There’s something about the addiction that makes people extremely defensive about their right to smoke…
LOL not so much wild as really, really nice. tnt in person is just like he is online (although I’ve found that to be so for most of the people I’ve met in person after friending them online), and Ben is a very kind, nice person with a twinkle in his eye. It was an extraordinary, positive, happy meeting.
Yeah, they are defensive because they know that smoking’s a really bad thing. I know, though, that it’s a really difficult addiction to conquer, and I have a certain amount of sympathy for that problem. But no sympathy for the attitude.
Owee owee it sure is. And back in the 80s when I had my GP look at it (which wasn’t so bad because she told me about her hemherroid adventures, and we had a good laugh) she was stumped. Had no idea. So she sent me to the general surgeon (GP said there was nothing he didn’t know) who did an uncomfortably thorough examination. He then informed me that it was a hygiene problem. OMG I thought I was going to die of embarrassment. I never complained about it again.
thats horrible! they should spend a whole year in doctor school to teach them the words “i don’t know”…
@Seenie, awww… that’s just shocking!!!.. unfortunately I’m sure you are not the only one to have felt that sort of embarrassment, and avoided mentioning any number of things in a doctors consult for fear of such a reaction… I agree with @Cynthia about some doctors needing to learn to say “I don’t know”… or at least finding a respectful way of addressing some potential issues… unfortunately they are no less human than the rest of us… this I understand… what I don’t understand is those docs who have no bedside manner at all… one has to wonder why they continue to work in medicine at all 