I have had PsA for about a year. Failed Enbrel and switched to humira in December. Had some house guests, kids were sick and spread to all my family. I developed sinusitis, BAD! Never had sinusitis before in 38 years. Rheum put me on Augmentin and told me to delay humira dose until sinusitis cleared. It is clearly SLOWLY. On antibiotic for 5 days. My PsA symptoms fluctuate almost daily. By schedule, I was suppose to take humira 72 hours ago but I fear the sinusitis will come back. But I also feel my foot pain/burning starting to ramp up significantly in the last 12-24 hours. This evening I feel extremely fatigued too.
Can missing humira dose really have this fast of an impact on symptoms?
If you are on humira and missed a dose, please share you experience.
It is definitely possible you are feeling the missed dose already.
I, personally, burn through my biologics quickly, and the day before the next dose is due I can definitely feel it. If I had to miss for several days (like for a sinus infection), it takes a few doses to get back to my baseline. Hence, I only miss a dose for serious infections, like you describe.
I'm curious why your rheum is prescribing for something a GP should be treating, and why, if you've never had sinus issues before, he went straight to Augmentin, which is EXTREMELY powerful. I would think a GP would have more experience and options for you.
The Augmentin, per my rheum, is the recommended drug of choice for a serious sinusitis. I had extreme pressure that would bud up and wake me from sleep every 2 hours, blood mixed with mucus, and my entire left upper teeth were completely numb (I guess that’s common with maxillary sinusitis).
FWIW, rheumys complete their residrncey in Internal Medicine and only accepted to a rheumatology fellwship bssed pn their ability as an Internist. They can handle a sinus infection.
I bet that some of your increased PSA symptoms are because you are so ill. I get frequent sinus infections and my doctor has recommended an over the counter saline rinse called Neil Med. I use it frequently and it has really helped. Hope that you are feeling better soon.
Thanks for another rude response. No wonder people leave this board. Obviously a rheumy can handle a sinus infection. Obviously also is that a rheumy is not the best person to treat one.
tntlamb said:
FWIW, rheumys complete their residrncey in Internal Medicine and only accepted to a rheumatology fellwship bssed pn their ability as an Internist. They can handle a sinus infection.
You may develop scar tissue in your sinuses from this severe infection. That may make you more prone to a recurrence. You should probably see a GP before symptoms escalate in the future; a GP is easier to get in to see than a rheumy.
A GP sees tons of sinus infections, and will quickly be able to ascertain what level of antibiotic should be used. A typical load of prescriptions for a sinus problem is decongestants and antibiotics (which you have), as well as a steroid spray (Flonase or Nasonex). The steroid spray helps reduce inflammation, thus shrinking the tissues, which allows a decongestant spray, such as Afrin, which you are using, to actually get up into the sinuses. A steroid spray is often to be used at the onset of any congestion for the next year, to keep your sinuses clear and draining. A saline nasal rinse is also suggested. If you get in to see a GP earlier in the infection cycle, you hopefully will not need the "big guns" of Augmentin, which is one of the most powerful antibiotics available for sinus infections (and can have powerful side effects as well).
Oetboy said:
Thanks for all your input.
I don't have a GP, but getting one.
The Augmentin, per my rheum, is the recommended drug of choice for a serious sinusitis. I had extreme pressure that would bud up and wake me from sleep every 2 hours, blood mixed with mucus, and my entire left upper teeth were completely numb (I guess that's common with maxillary sinusitis).
I just started my first biologic last month. One of my questions was, if I get sick, and I'm scheduled for an injection, who do you want me to call, the rheumy or my GP? Surprisingly enough, my rheumy ask that I call her for an appointment. This may be because I am just beginning on a biologic, not too sure.
You should always call your rheumy if you are new to a biologic and want to know whether to skip an injection.
Stoney said:
I just started my first biologic last month. One of my questions was, if I get sick, and I'm scheduled for an injection, who do you want me to call, the rheumy or my GP? Surprisingly enough, my rheumy ask that I call her for an appointment. This may be because I am just beginning on a biologic, not too sure.
Most or many Rheumys prefer you call them. Remember they have many more years of training and experience in primary care than most "GP's" any while a PC physician (or his nurse practitioner these days) may see more "sick people" sinus infections etc., it is highly doubtful they have seen as many patients being treated with the range of meds and immune system effecting meds as the Rheumy. When you get sick you are on the immuno-supressent drugs. You want an expert in those drugs first. Its not always necessary to stop them Not all infections are equal. They know the difference.
Stoney said:
I just started my first biologic last month. One of my questions was, if I get sick, and I'm scheduled for an injection, who do you want me to call, the rheumy or my GP? Surprisingly enough, my rheumy ask that I call her for an appointment. This may be because I am just beginning on a biologic, not too sure.
Well, I guess everyone has rheumatologists who can see them at the drop of a hat to treat infections, and no need for a GP! Because a rheumy is THE BEST person to treat sinus and other infections.
tntlamb said:
Most or many Rheumys prefer you call them. Remember they have many more years of training and experience in primary care than most "GP's" any while a PC physician (or his nurse practitioner these days) may see more "sick people" sinus infections etc., it is highly doubtful they have seen as many patients being treated with the range of meds and immune system effecting meds as the Rheumy. When you get sick you are on the immuno-supressent drugs. You want an expert in those drugs first. Its not always necessary to stop them Not all infections are equal. They know the difference.
Righto kids, its not about you, or who’s right or wrong.
We all have different relationships with our Rheumys and GPs, they each have different skills (my GP is not equal to yours for example - he can’t remember what Humira is), so who to see for what is often very situation dependent.
I think the point is that the OPs course of action in taking his rheumys advice is sensible, and that other people have different experiences in their treatment relationships.
Now if you’ll excuse me, I’m off to an appointment with a new GP who hopefully might at least recognize the name Humira after I’ve seen him 5 or 6 times!
Whoa, now folks! Let's simmer down a little. I am 99% sure that Lamb did not mean offense in the first post. Reading it as an outsider, I simply see a matter of fact statement. Over the interwebs, I can see how that might be viewed as brusque, but I am sure it was not intended that way. Let's ALL take a step back and let. it. go.
Both points have merit here. Everyone needs a GP. They are the conductors of our care and help keep us organized. Plus it's good to have one practitioner who knows us well. That said, I tend to agree that our Rhuematologists have more than a passing interest in our sniffles and snorts than our specialists would, and I guess that is because of our medications.
I agree, Marietta, Augmentin is a heavy hitter, but my PCP prescribed the very same thing for my last bout with sinusitis. I thought it was a little bit of overkill, but he insisted. I'd had symptoms for at least 10 days though and had been doing all of the home remedies and OTC products that I can take.
Remember that I love you all. Damn, I hate it when the family fights. It makes me want to hide under my keyboard until its over.
I hope you’re feeling better soon, Oetboy, and can get back to treating your PsA. I had a major AS flare along with a minor PsA flare when I was a week late with my Remicade infusion due to a snowstorm.
I was very thankful when my endocrinologist took time to address an infection in my face at my 5:00pm appointment with 3 of my kids in tow, to save me a trip to my PCP. She even called and left him a message letting him know the prescribed course of treatment. Flare + child with Aspergers bouncing off the walls + late in the day appointment + infection that needed attention asap could have equalled disaster if it weren’t for her compassion and expertise.
Back to the augmentin. 5 days is barley enough, I'd be a bit worried too aboit a reinfection. By the same token it takes a bit to get a full load of humira on board, so you likley have some wiggle room. If I remember the formula from way back when it takes two times the dose frequecey to get to the half life. FWIW I start to miss my boilogic a day or two before I'm due. Generally though you'd feel it axially first.......