Hot off the press

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I just happened to come across this article today, and noticed that it was only published yesterday! So truly hot news.

Why it’s in the dermatology journal, I don’t know. The reason I was looking at dermatology is because I was looking for a topical for the psoriasis on my face. But that’s another thread.

In case the link doesn’t work, here’s the text of the article:

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CONFERENCE COVERAGE
Pain often persists despite biologic treatment in PsA
Publish date: June 16, 2017
By: Jennie Smith Dermatology News

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AT THE EULAR 2017 CONGRESS

MADRID – Pain is common in patients with psoriatic arthritis (PsA) and can be disruptive to their lives and jobs, even among those whose inflammatory symptoms have been treated with biologic drugs for 3 months or longer, according to findings from a multinational survey.

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Treatment & Diagnosis of Psoriatic arthritis
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At the European Congress of Rheumatology, Dr. Philip G. Conaghan of the University of Leeds (England) presented findings from the survey of 782 consecutive PsA patients from 13 countries in Europe, the Middle East, Asia, and the Americas, as well as Australia. All patients included in the analysis were on biologic agents – mainly tumor necrosis factor inhibitors – for at least 90 days.

Dr. Philip G. Conaghan of the University of Leeds (England)
EULAR2017 - Streaming.hr
Dr. Philip G. Conaghan
About one-third of the cohort reported little pain or mild pain, 30% reported moderate pain, and the rest – 37% of the cohort – reported severe pain despite treatment with biologic agents.

In an interview. Dr. Conaghan said that it’s important for clinicians not to assume that pain in a PsA patient on a biologic means that the drug is not working.

“The main limitation of our study is that we haven’t worked out how well-controlled patients’ psoriatic arthritis is, so, although we know they’re on a biologic for more than 3 months, we don’t know if they were responding well to it.” But, even in the absence of systemic inflammation, he said, there are other potential causes for pain that should not be overlooked.

“There’s no reason why PsA patients wouldn’t have pain due to tendinitis, enthesitis, and osteoarthritis – the same mechanical-type joint pain that we see in the whole community of people over 40,” Dr. Conaghan said. “I am concerned that, once we give someone a label of inflammatory arthritis, we stop looking at all the other things that can happen to their musculoskeletal system.”

Moreover, he said, “people who’ve had arthritis severe enough to need a biologic treatment will have muscle deconditioning and weakness. It’s very common that PsA patients have trouble opening jars and getting out of chairs.”

Such weakness “can lead to mechanical joint pain, which fortunately can be improved – along with the pain – through muscle strengthening and rehabilitation.”

For their study, Dr. Conaghan and his colleagues collected information from clinicians on treatment and from patients. The questionnaires incorporated several measures of disability, pain, functional impairment, and health-related quality of life that have been validated for use in PsA patients.

Severe pain was significantly associated with increased use of prescription nonsteroidal anti-inflammatory drugs and opioids, as well as nonprescription pain medication. Patients 65 years and older had a significantly greater likelihood of being unemployed or retired because of PsA if they reported severe pain, compared with those reporting mild or moderate pain.

A number of quality of life and work-related measures were also associated with pain severity. Dr. Conaghan and his colleagues found that the risk of disability increased with bodily pain, and more severe pain was associated with greater activity impairment, worse social functioning, more work impairment, and work time missed, among other measures (P less than .0001 for all).

“What we saw is that, the more pain you have, the more your world shrinks in,” Dr. Conaghan said.

Dr. Conaghan reported financial relationships with AbbVie, Eli Lilly, Novartis, Pfizer, Bristol-Myers Squibb, and Roche. Some of his study coauthors have similar disclosures. Four coauthors are employees of Novartis.
PSORIATIC ARTHRITIS PSORIASIS

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The link worked fine. It’s an interesting article.

It just confirms that supportive measures are often needed, and should include physical therapy whenever it’s appropriate.

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It makes sense to me. I have more pain as time goes on. Not the screaming hab dabs pain of stiff and swollen joints, but extensive and a right downer sometimes.

Only slight issue is, depending on how you read this, the author could be implying that tendinitis and enthesitis are not central to PsA. My rheumy said that for some patients, enthesitis is the main symptom. He mentions OA too, but that subject is best avoided by me! However he’s so right that the whole musculoskeletal system should be taken into account, otherwise it’s like tuning the engine on a car with flat tyres.

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Yup, it all made a lot of sense to me too. I have pain as well, and not just what’s from foot damage. (That doesn’t count.) I have a chronically painful elbow that’s tender to the touch, so I don’t. And I have back and hip aches which are probably related to my SI. It’s reassuring, though, to know that it doesn’t necessarily mean that the disease is not controlled. X-rays that I’ve had fairly recently seem to confirm that my joints aren’t getting any worse.

Glad I found that article!

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That’s a great article and yes, our “other” pain, whether resulting from PsA damage, age, or unrelated injuries is hard to deal with. If only our biologic would be a cure-all for everything!!!
One interesting pain that was mentioned was tendonitis being a separate problem, unrelated to PsA…I had tendonitis in many places before I took Enbrel–it was one of my worst PsA symptoms–I haven’t had it at all in my wrists or shoulders since I’ve been on Enbrel. However, I sort of have it in my ankles as part of my foot complaints–it’ll be one of those things I bring up in my upcoming rheumy appointment.
I guess we can blame aging on some of our pain–it’s still hard for me because I think my parents were either extremely tough or age didn’t catch up to them at the same rate it’s catching up to me. I have a really hard time accepting that I’m not as tough as they were!

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There was a fascinating article some time back on remicade that even for those who showed less, or no, erosions on remicade, as compared to placebo, only a proportion actually had reduced pain and increased quality of life.

Pain is a very complex beast indeed!

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@Grandma_J- you said, “I guess we can blame aging on some of our pain”.

But keep in mind that we have members in their twenties and thirties. Aging is clearly not a factor for them.

And, my mom had undiagnosed PsA for close to 15 years before diagnosis. If turns out that much of her “aging” related pains were positively impacted by the start of meds for PsA.

I know that some of my xrays show joint space narrowing that is more like that of a 60 year old, from my early forties. And a cataract in my eye by 45? Clearly not just aging.

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Good point Stoney - at diagnosis I sat there hortified as my Rheumy told me, (age 36), that ‘we all get a few aches and pains as we age’

I felt like saying, ‘so were your ears painted on when I told you the part about how I went from going for 10km hikes to not being able to walk 500m up the street without a rest in the space of six weeks?’

Six years later, and a whole lot more ‘patient experience’ under my belt, I probably would say it, if not exactly in those words!

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That was my age at diagnosis too, with a nine month old baby. I could barely get up off the couch that first year post diagnosis and ran low fevers much of the time. Definitely not age related.

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Ooops I hope I didn’t sound like younger people’s pain is age-related…I just meant that most likely some of mine is age-related, especially since O/A can be age-related and I think most people experience some O/A as they get older…some, not until their 90s and others in their 40s, but it seems like sooner or later nearly everyone will have some osteoarthritis. It’s very unfortunate when the inflammatory and osteoarthritis, not to mention all the other related ailments or any serious disease for that matter, happen at a much younger age–so unfair!!! I just meant it’s not unusual to have aches, pains and stiffness more as an older person.

That is something I’ve heard from my doctors, too:

It IS as if they’re not listening sometimes!

I had plantar fasciitis when I was 40. I had the symptoms for about 6 months before I went to the doctor. I explained my symptoms and said, I guess it’s a sign I’m getting old, to which he laughed and said, no, this is not normal aging–you shouldn’t have pain like this just because you’re 40! He put me with a physical therapist and the right treatment and wearing good, sturdy shoes 24/7 for awhile with orthotics cured my feet at that time. I didn’t really have problems again until my 50s when the neuropathy started…it’s been downhill from there.

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I’m reminded of the orthopaedic surgeon who referred me to rheumatology. He said it didn’t seem right that I had simple wear & tear as I was ‘so very young’. I was 54. I scrutinised his face for signs that he was just plain taking the … and couldn’t see any. I don’t know why but there was something I really, really liked about that guy. Then once you get a 6 upfront some docs all too readily put it all down to flaming ageing.

Anyway my current rheumy said she thinks it’s very likely I’ve had this stupid thing at least at background level since adolescence.

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Thanks Grandma and Sybil - it’s not age (or those of you who have it) we are frustrated with - it’s the docs!

Those ones that don’t accept it as age-related issues are worth their weight in gold - my GP was the only reason I got my diagnosis in the first place - with others, and Rheumys like mine, I fear we’d all be hobbling around at 30, 20, 40, 60, being told it is ‘just age’.

So here’s to the sensible ones who smile, laugh, or just look downright concerned, and acknowledge - that’s not normal!

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My knees went downhill very quickly, starting at age 50. By 55 I’d had two replacements. I asked my GP more than once whether something else could be going on with such a rapid deterioration. She poo-poohed that (sorry, Poo… LOL) and said that “OA can work fast”. Of course, that was the quickest and easiest response.

Right. Six utterly miserable years of pain, fatigue and depression later, I was diagnosed with PsA. Bitter? Me? Noooooo…

Amazing, Sybil, that you most likely had this dastardly disease fulminating for decades. Horrible thought.

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(this topic never showed up in my new topics thing until now…)

But the article just said that if you have pain you do less?.. and to not forget that pain can also be non related to PSA…

When I started reading I thought he was going to conclude that the pain can linger because the brain is afraid it’s still there… like fantom pain (wait is it fantom in English? I mean the pain you can get in a limb even if it’s amputated because the brain thinks there is still a threat to the limb)

Like the opposite of what happens if you put a coin o your hand and after a while you forget it’s there… this time the cause of the pain is gone but your brain doesn’t realise it?