I am looking for some advice. I have tried methotrexate tablets - bad side effects. They moved me to the injections - which pretty much ruined my life due to the crippling nausea.
Went to the rheumatologist last week who kept trying to get me to go back in on methotrexate- which I am categorically not doing. He then mentioned two other alternatives. sulfasalazine Or leflunomide and asked me which one I wanted. My response - I don’t know - I know nothing about them. You are the doctor - so I rely upon you.
I also had trouble with MTX but not as much as you. It gave me sore joints…great side effect when the cure also causes the problem! I was on sulfasalazine
for about 6 months. I was on MTX, sulfasalazine and celebrex and was in a lot of pain…they did little for me and the sulfasalazine gave me sores in my mouth, flu like symptoms and psoriasis present. It caused me to change rheumy’s and the new one said, “the dmards are like using a water pistol to control a fire and got me on biologics. A good rheumy should know within 6 months if you are on the right stuff. BUT, in Canada, three dmards need to be tried and failed before switching to the “real”stuff…biologics. Hey, that’s just my story, there are others who are doing well on dmards.
They are both first line PsA meds like methotrexate (mxt) is. They work differently however. Mxt hated me but sulfasalazine loved me and even worked well for a while. Given I live in the UK also, I wasn’t required to also try leflunomide (called ARAVA in the USA) as our PsA treating protocol permits biologics to be considered if two of these three meds fail to to reduce your PsA disease activity enough and you have enough in the number of affected joints.
People have responded well to all three meds which is why they are tried first by the NHS. The funding arm of the NHS called NICE has a treatment protocol for PsA which your rheumy should follow and is appearing to be following just anyway.
Always fear the disease far far more than any med suggested to help. Meds can be changed, the damage caused by this disease can’t be. Your rheumy should have given you leaflets about both of them to also look at also.
Incidentally do research PsA yourself - it helps when you’re educated about it and allows you have more decent conversations with your rheumy too. Sadly with our NHS presently too many medics are over stretched to spend too much time explaining things. So always seek to help them help you, if that makes sense, by being an informed patient. A really good place to start in the UK is the PAPAA website for all things PsA and psoriasis. It’s a far better forum than Versus Arthritis which sadly has given out lots of misinformation about PsA over recent years. The PAPAA website talks in detail about the NICE protocol on treating PsA too which gives you an overview of what to expect going forward too. And that always helps as sadly we as patients often have to try many before we find one that works for us individually.
No problems with Methotrexate here, still use it (weekly injection) in combination with a biologic. But, before I turned 65 and could “afford” the biologic, I was on it in combination with leflunomide. Worked ok, until my white blood cell count dropped so dramatically that the lab called my doc at 10:00 pm and I ended up in hospital for a week. With a decreased dosage, I muddled along until my government medication birthday.
Just be aware, it can be dangerous.
I feel you, friend. I have Psa. I have used methotrexate twice. The first time orally. (Over a year.) The second time, shots.
The first time, I could nor function on the day I took it due to fatigue and nausea. The second time, the side effects were less… kind of.
That said, it worked! My crooked hands straightened up. I could move my big toes, which I hadn’t been able to for two years. My psoriasis was almost gone. It’s just those effing side effects…
I’m now on Humira, having moved from Enbrel. But the worst part of my Psa is still being held a bay. If I had an uncontrollable flare up, I would use Methotrexate again. And also look for the first chance to get off of it.
Methotrexate put me in the hospital for 10 days. Nobody knew what was wrong at the time. It was like I had severe pneumonia but X-rays didn’t show. What was finally figured out is my entire lungs were like they had a netting all through them. After massive IV steroids and massive IV antibiotics, they started clearing up. The drug almost killed me. But it’s the first line of defense for PsA for many insurances. Nasty drug in my opinion, of course. Lol
I also went through 7 biologics and each failed miserably. I went to my dermatologist and she suggested Otezla since the injectables weren’t working. I’ve been on it for 5 years now and my skin is clear and my pain is manageable. I’m not pain free but I’ve had this for 35 years. PsA wasn’t even a blip on the radar at the time I developed the pain.
