Going to the reumatologist for more than just tests and x-rays this time. What can I expect?

I am going to be attending my first reumatology appointment to discuss medication and treatment options. The testing is complete and the x-rays show erosion several joints. The blood tests, x-rays and exam by one of the leading reumatologists in the county all show definite PsA. I was screened for a drug test that was to include Humira as one of the biologics possible but the diagnosis itself was only one day old and it needed to have been six months out to participate I have been waiting for this appointment for almost two years now as I have lumbered my way through the field of disbelief that this was happening to me. Both from within my self and from my physicians. I have prevailed at last and I am here to find out all can about what to expect.

I know that every case of the disease presents differently for each individual, making a standard treatment rather absurd but a little push in the correct direction would be very helpful indeed. I do not want to continue on the Kenelog because of the weight gain and emotional drawbacks over a long period of time. I am afraid it will rebound in the skin department. My derm seems to feel the same way and advises against the steroids.

My skin is well controlled now and I am mostly suffering from incredible pain in my hip, all the way through and my fingers and hands/wrists. The steroid seems to do well to control the weakness and fatigue wall I hit if I'm not careful to exercise then rest in cycles all of the time. I need at least ten to twelve hours of rest a day including sleep periods. I usually end up falling asleep at 7:00 in the evening no matter what I want to do.

A little help here so I know what to expect would be very welcome. Thanks in advance....

I don't know of many if any rheumys prescribing Kenelog. Its a pretty old drug with tons of nasty side effects and hard one to get off of. You most likley will be started on a DMARD (MTX, sulfazine etc.) as most of your joint problems are peripheral not axial and the fact is these will be most likley to have an immediate effect and do the most for your symptoms. I would suspect they will keep you on the kenelog for a month or so maybe two and then start a taper. I imagine they will also add a regular prescription dose NSAID. Its doubtful you will start on biologic at this point. Depending on your insurance company you may need 5 joints and axial (spinal) involvement or SI erosions (MRI necessary for that)

In any event not a whole lot will happen. A good Rheumy takes baby, baby, steps evaluating each change and each effect. Thats the ONLY way to get to a program for you.

Good Deal -nice to hear it put out like it is! I was hoping to get off of the stop gap Kenolog, he only prescribed it because it was available at my small clinic and my insurance didn't cover his visits. I was hoping not to have to start on the heavy stuff as the Naproxin do work for the pain and swelling . It's that wall of exhaustion that I fight with . I've had the arthritis for so long I just use a good topical ,take an advil and call the heating pad my best friend.

It was the psoriasis and the migraines that put me over the edge but I believe we are getting a good handle on both of those issues as well. We will be doing a good close look at the spine as most of the first issues I had started ten years ago there. I'm not looking to hurry ,just to do it correctly. Thanks for the time and advice:)