Hi all,
On my lab rat journey through the medication maze I was eventually put on Humira. It took about 6 weeks to feel any difference and get that first glimmer of hope that things might be getting better. After about a month of slight progression in the right direction it began to regress. Rheumy advised to stick with it and to come pay him another office visit in 6 weeks. 6 weeks later I was back to where I was prior to the Humira. I was switched over to Embrel, this time it was about a month before I felt any improvement but withheld the hope after the let down from Humira. Well its been 3 months now and i’m right back where I started before I ever put any kind of biologic to work inside me. Ive read the many trials and tribulations of the biologics here, seems like its throwing lawn darts at an ant on speed to get it right?!?
Soon to go back to the Rheumy and I would like to know before hand is Remicade going to be any different? Is any biologic going to be any different at this point? What comes after biologics?? He keeps pushing Remicade but I figure that is because then he gets paid for administering it at their office. I am a medical billing manager so i may be a little jaded and skeptical lol 
There is a bunch of them. Remicade is the nuclear option as far as the anti TNFs go especially if you have spinal involvement. It was once thought TNF inhibitors were the way to go for PsA I suspect its because they have the most research. The fact you have had some relief from the anti TNFs is probably why he is working his way through them. You might ask him what the plan is.
I suspect the next step will be the Interleukin 12 and 23 meds. The other thing you may want to be very careful of are what your expectations are. If the measures you are using are based on some specific pain(s) its possible that its not PsA but osteo or other permanent damage that won’t be effected by any biologic at the same not using a biologic can create more of the same kind of damage.
Your docs physical exam is critical, he needs to chart every “tender point” bad spot etc and evaluate through the whole process. Your possibly subjective evaluation may not be enough. Often times when we have been in pain and have had long term specific pain, even after its gone (there are ways of knowing) you immune system (which is screwed up to begin with) keeps telling you you are still in pain trying to “help you out”
That problem can be fixed usually with antidepressants (tricyclics) or other medicines. In any event its rare that they can’t get on top of the whole thing, it just takes time. Oh I can tell you with a fair amount of authority that Infusion centers are money loser for Rheumatology clinics and its the last meds they want to give. Its the only one medicare pays for and their reimbursement is very poor for infusion centers.