My take on this is that it comes down to the fact that symptom control isn’t the same as disease control. There are a lot of things that can relieve symptoms including certain drugs and hot tubs (of which I am extremely jealous!). But if we don’t actually control the disease then our problems are likely to get worse and / or diversify.
Of course when disease modifying drugs work by slowing down the destructive effects of PsA, a lot of the symptoms are likely to improve.
You are so right though, in my view, about the difficulty of knowing whether a drug is working well enough or whether it’s starting to fail. If swelling is down, that’s a key sign that it’s working. But stiffness and persistent pain in certain areas does make you wonder doesn’t it? I guess x-rays etc. taken at intervals are a key way of monitoring whether joint damage is occurring or worsening. And so much depends on communication with the rheumy and their judgement too. I gather it’s not necessarily that easy for rheumys to assess how well a biologic is working sometimes but it’s got to be something they take seriously. And the way we communicate what has been happening is important too. I haven’t communicated with doctors too well recently and I know I’ve got to sort that.
We have already determined that the Imaging is not used for Dx or probably even looked at for that matter, so that would be left to the physical examination and symptoms improving, to determine the effectiveness of a biologic drug. Especially those patients that a seronegative to blood work, and have very little swelling. I don’t know of a test that will tell you if major organs like the heart is being attacked by PsA, there might be some indication in the blood work, or maybe a MRI or CT imaging?
I have blood work every 60 days, an echocardiogram every 3 months, a liver needle biopsy annually, a pulmonary function test annually and a colonoscopy every 18 mos in addition to a vision field test monthly and PT work test monthly. My PsA has moved to several organs. SO FAR Humira and MTX are holding things steady (with a few exceptions that require some extra help) We don’t even ask about joints anymore. Normally most just need regular chemistrys and periodic echos
I agree. If I didn’t have the little nagging things to concentrate on I wouldn’t care as much. In the long run that is a very bad plan.
For me muscle and tendon pain come from the original source, the PsA pain. I walk funny if my knees are bothering me… so back pain. I type odd because my fingers are flared out with P, hand and wrist pain, etc. You might find if you manage the PsA you will see some of these other issues go away. Of course, sometimes they don’t.