in September of 2024 I had a right hip replacement with two bad knees. the hip replacement went well but the left leg over compromised and now the left knee is swollen to the point I still am walking with a cane and the pain and discomfort is taxing. The Ortho wants to do the left knee first since it is very large and needs replaced but my husband is having his done this coming Monday from wear and tear of a football injury so waiting to see how his goes and watch what he goes through. Meanwhile the rheumy is wanting to change biologics, skyrizi to something for he does not like the looks of the knees but knows surgery is impending. I asked him what biologic he would be considering since this would be my third one…Embrel, Skyrizi and ? He said he does not know but continue with the MTX and wants to add Arava (spelling) to see if that helps with the knee swelling. I am so defeated and do not know what to do. Do I agree to a new biologic while I know I am next for a knee or wait? Do I chance going into a flare while taking care of my husband? How do people do taking both MTX and A. Any insight wold be appreciative.
Using mxt and arava (leflunomide) is a tried and tested treatment method for people who usually haven’t got to the stage of being elegible for biologics like in the UK as we have a protocol of when we can be eligble to try biologics. Both are cDMARDs and using both together is better than just one, often. So we in the UK wouldn’t call it a big deal if that helps.
Your rheumy is being sensible delaying the start of a new biologic until a decision over your knee replacement is made. As stopping and starting a new biologic pretty much within its first year puts you firmly on a trajectory of that med failing you as the stop and restarting permits antibodies to grow to the biologic. And you must stop biologics for such surgery sadly. So what is the point of that? We can stop and start mxt and arava as often as required, we don’t grow antibodies to those.
However are you now taking mxt and Skyrizi and would arava be added to that combination? I would worry about have three such meds in my system at the same time as that quite hard to endure. Or is he simply going to drop the Skyrizi as it isn’t doing enough?
Why hasn’t developed a treatment plan for you on biologics? You haven’t tried Humira, Simponi, Cimzia, Cosentyx, Talz or Bimzelx yet, just to mention a few. Neither have you tried Stelera or Tremfya either.
Far more coherently why isn’t mentioning the possibilities of JAK inhibitors presently. They are different to biologics on the same level and are taken in tablet form and can be stopped and started again, something like Rinvoq is used for PsA.
As you can see there are several options for him to think about. But he should be giving you those treatment options, so why hasn’t he?
As for your husband’s rehab the more he does of that himself the better his replacement will be. But yes initially you are going to be dealing with lots of ice or an ice machine and needing to help get about to the bathroom etc and fetch his pain relief food and drinks too.
Hope this helps.
we have talked about other biologics or something but he is hesitant to start something now because of my husbands upcoming surgery. he does not want me to go into a huge flare while waiting for the new drug and i cannot help my husband.
yes he wants to add another drug to my body with the biologic and I am so against this. i spoke to my pharmacist and he told me not to do it for if i have a reaction but husband woiuld not be able to help me, if it is life threatening, and with out bad weather right now it is too much of a risk. so it is is the que for him to fill when I call. the pharmacist does not like all of these meds on my system for if something should go wrong how would I know which one. Disclosure…the pharmacist is a dear friend of mine who I have known for many years and I go to her for questions abouts meds and use her for store which a small store instead of a large one like Walgreens. so helpful!!!
back to me,
I had such good luck with Embrel for 12 years and they went south quickly. tried humara but that did not work so switched to skyrizi which is not doing its job on joints in my opinion.
the hip surgery I had went well but boy is my body angry with me having it. feel like it’s fighting having a foreign body in my body and it is letting me know.
i am at lost right now but trying to stay positive