My rheumatologist gave me prednisone after being diagonsed with the PsA.. to help with the pain, it did not help and i stopped taking it after 4 days because my head felt like it was going to explode i had such horrible headaches.. after reading that it actually makes the PsA worse i wonder does she even know what she is doing? I am on the mtx now for a month and i have read their is no evidence it stops psa from further damaging your joints.. why am i taking it if there is no proof it even works??? I am so upset right now. the next time i see her i will demand some answers.. i am not going to risk permanent damage to my liver taking somehting that so far has not helped me at all. she said it could take up to 3 months for the mtx to help.. does anyone have a doctor that knows what they are doing that is locted in Western suburbs of Chicago???
I wouldn’t be too quick to write off the prednisone and the mtx just yet. For a short-term “patch” while you’re in the gap, prednisone can be useful. (It can also give the doctor an indication of whether your pain is coming from inflammation.) Of course, if it gives you the headache from hell, it’s a non starter for you. MTX is an interesting one: there are some studies which suggest that in PsA, it’s better at symptom control than it is at damage control. Still, it works for some folks and it has the advantages of being cheap and being a time-tested med. Many of us, who got no relief from it, continue to take it with a biologic because there’s a feeling that biologics may work better and for longer with the mtx than without. Who knows.
As far as liver damage goes, your blood work (which I assume you are having done on a regular basis) will give an early warning of potential damage. If your liver numbers creep up, they will discontinue it and your liver will recover long before there’s permanent damage. Three months is a very normal trial period.
Yes, this whole business is upsetting, isn’t it?
Have you picked up the book that I recommend in BOOK REVIEWS? A good layperson’s guide, quite comprehensive and easy to read.
Thank you Seenie, actually I bought the book from amazon and it read to me like "MTX was not proven to help but still keep taking it because all the evidence is not in yet". that is alarming because the drug has been around for so long and has been used for psoriatic arthritis for so long, I cannot believe there is no conclusion yet on whether it stops damage or not.
yes, i did get my blood tested once so far while on the mtx and things were good.. however, i was not told that i need to keep going to keep my blood tested and my dr is out of the country on vacation right now.. am i suposed to go a certain amount of weeks on a regularly basis? so sorry for all the questions but i am so confused right now. i am so tired and my neck and foot are killing me and I was not even told if these are normal symptoms of the disease by my dr.. can someone tell if the disease will progress to the mutilans type? how bad will the disease get?
Seenie said:
I wouldn't be too quick to write off the prednisone and the mtx just yet. For a short-term "patch" while you're in the gap, prednisone can be useful. (It can also give the doctor an indication of whether your pain is coming from inflammation.) Of course, if it gives you the headache from hell, it's a non starter for you. MTX is an interesting one: there are some studies which suggest that in PsA, it's better at symptom control than it is at damage control. Still, it works for some folks and it has the advantages of being cheap and being a time-tested med. Many of us, who got no relief from it, continue to take it with a biologic because there's a feeling that biologics may work better and for longer with the mtx than without. Who knows.
As far as liver damage goes, your blood work (which I assume you are having done on a regular basis) will give an early warning of potential damage. If your liver numbers creep up, they will discontinue it and your liver will recover long before there's permanent damage. Three months is a very normal trial period.
Yes, this whole business is upsetting, isn't it?
Have you picked up the book that I recommend in BOOK REVIEWS? A good layperson's guide, quite comprehensive and easy to read.
Giuila, thats not true about MTX. I assume you are referring to the 2012 British Study which has developed a life of its own. It is touted heavily by those promoting biologicals as the first line of medication. No serious medical center take it seriously, in fact Eric Matteson, at the Mayo Clinic openly laughs at it. (although he rsepects the effort)
There were a number of problems with that study. First of all it had a quarter of the number of patients to be involved for it to be legitimate. Secondly it didn't define who the patients were. They took all comers. There are 5 nnown types of PsA and each is different. The study was only six months and then concluded. It admits that patients on the whole FELT better and had fewer symptoms including skin improvement. they then went on to say despite the improvement in patients the medication had no "Disease Modufying Effect" (at odds with many other longer term studies)
There are three problems with that conclusion. First six months isn't long enough to determine a DMARD effect its barley long enough to know if the drug has an effect. Secondly they used ESR and CRP data which they didn't say was statistically effected, of COURSE it wasn't ESR and CRP levels are rarley effected by PsA to begin with. Third they measured synovitis levels to see its effect on joints and such. Great idea EXCEPT synovitis is what happens with Rheumatoid arthritis. We get something different called enthesitis. They evaluate that (likely because it takes a good MRI)
If didn't know better, I would say these folks didn't know much about PsA.
There are multiple studies confirming MTX positive effect on peripheral symptoms (the biologics aren't so good at that) Most of the biological companies have data confirming better efficacey with MTX of their meds as well as extending their useful life. Do I like MTX? Nope Do I take it? Yup.
tntlamb said:
Giuila, thats not true about MTX. I assume you are referring to the 2012 British Study which has developed a life of its own. It is touted heavily by those promoting biologicals as the first line of medication. No serious medical center take it seriously, in fact Eric Matteson, at the Mayo Clinic openly laughs at it. (although he rsepects the effort)
There were a number of problems with that study. First of all it had a quarter of the number of patients to be involved for it to be legitimate. Secondly it didn't define who the patients were. They took all comers. There are 5 nnown types of PsA and each is different. The study was only six months and then concluded. It admits that patients on the whole FELT better and had fewer symptoms including skin improvement. they then went on to say despite the improvement in patients the medication had no "Disease Modufying Effect" (at odds with many other longer term studies)
There are three problems with that conclusion. First six months isn't long enough to determine a DMARD effect its barley long enough to know if the drug has an effect. Secondly they used ESR and CRP data which they didn't say was statistically effected, of COURSE it wasn't ESR and CRP levels are rarley effected by PsA to begin with. Third they measured synovitis levels to see its effect on joints and such. Great idea EXCEPT synovitis is what happens with Rheumatoid arthritis. We get something different called enthesitis. They evaluate that (likely because it takes a good MRI)
If didn't know better, I would say these folks didn't know much about PsA.
There are multiple studies confirming MTX positive effect on peripheral symptoms (the biologics aren't so good at that) Most of the biological companies have data confirming better efficacey with MTX of their meds as well as extending their useful life. Do I like MTX? Nope Do I take it? Yup.
Thank you so much for your comments..Yes, that is the study I had mentioned and I did not know that it was such a poorly conducted and uncontrolled study. I will definitely have a better attitude now while taking the medication. I really appreciate everyones helpful replies.
Seenie is correct about Predi being a "gap drug" My fifteen year old Spectrum kid recently finished a round. She survived and I'm not in prison so it was a win-win............. She has started MTX and will be starting Enbrel as soon as any symptoms from the MTX stabilize. Her rheumy starts one at a time.
Not only was the poor kid moody (something that just breaks her heart) now thats she's done the P break out in belly button ears and crack (none of which were barley noticeable before) are horrible. BUT ther is good news, she is no longer pushing Grandma for Thong underwear, pants that barely cover her butt (like ALL the other kids are wearing,) and doesn't cry getting out of bed.
I think having to deal with this disease as a 15 year old in this day and age must be horrendous. I feel for her.. I hope she feels better quickly
Giulia, I don’t know how often other people have their blood work done, but I am supposed to go once a month. I actually go once every six to eight weeks or so.
There’s an interesting topic for a post! Why don’t you ask what other members who are on MTX are doing?
Lamb, I don’t think the “Facts” book is referring to the 2012 British study, because I believe the book was published before that.
Yes, the book seems to discount mtx, but the interesting thing is that I am still on it with my Enbrel. And my rheumie is the author of the book!
Its effect on peripheral symptoms is pretty significant (your feet withstanding) I get the impression the "good guys" don't like it as stand alone treatment.... It has little effect on axial symptoms. It DOES make many "feel better" but then as remeber from the 60's there are a number of "substances" that do that.
Lamb, you can remember the 60s???
That's because although I'm close, I'm still not to the 70's yet......................... The 50's are a bit of a problem....
Seenie said:
Lamb, you can remember the 60s?????
I want to mention that the dermatologist I saw yesterday (she was from MAO Clinic in MN, now has her own practice). She told me that Methotrexate will soon be a thing of the past. IDK where she got her info, but I'm just repeating what she told me. She doesn't prescribe it.
tntlamb said:
Giuila, thats not true about MTX. I assume you are referring to the 2012 British Study which has developed a life of its own. It is touted heavily by those promoting biologicals as the first line of medication. No serious medical center take it seriously, in fact Eric Matteson, at the Mayo Clinic openly laughs at it. (although he rsepects the effort)
There were a number of problems with that study. First of all it had a quarter of the number of patients to be involved for it to be legitimate. Secondly it didn't define who the patients were. They took all comers. There are 5 nnown types of PsA and each is different. The study was only six months and then concluded. It admits that patients on the whole FELT better and had fewer symptoms including skin improvement. they then went on to say despite the improvement in patients the medication had no "Disease Modufying Effect" (at odds with many other longer term studies)
There are three problems with that conclusion. First six months isn't long enough to determine a DMARD effect its barley long enough to know if the drug has an effect. Secondly they used ESR and CRP data which they didn't say was statistically effected, of COURSE it wasn't ESR and CRP levels are rarley effected by PsA to begin with. Third they measured synovitis levels to see its effect on joints and such. Great idea EXCEPT synovitis is what happens with Rheumatoid arthritis. We get something different called enthesitis. They evaluate that (likely because it takes a good MRI)
If didn't know better, I would say these folks didn't know much about PsA.
There are multiple studies confirming MTX positive effect on peripheral symptoms (the biologics aren't so good at that) Most of the biological companies have data confirming better efficacey with MTX of their meds as well as extending their useful life. Do I like MTX? Nope Do I take it? Yup.
That may be true for Dermatology as it works less well for psoriasis but Rheumatologists will still be prescribing frequently for Psoriatic Arthritis. I see both and my Dermatologist has stopped using it for her psoriasis patients but knows that those of us who also have PsA will continue it.
This discussion is really interesting, especially all the variance in what doctors provide.
For me, MTX cleared my skin really well, and fairly quickly. That said, my P was really minor, just some classic plaque lesions on my elbows. I've been on it for two years+ now. Can't tell how much good MTX has done for my joints. They have worsened significantly, but they might be worse yet without the meth.
I've also been on 5 mg prednisone for two+ years. Today, that got upped to 10mg for awhile, as I've just started PT and it seems to have set off a huge flair. I hate the stuff with a fiery passion, but until something else works, I'm stuck with it, I guess. I'm currently on my third biologic, and it seems to be helping, but it's a slow go. When this injury is resolved, one way or another, getting off the damnable prednisone is my first priority.
For what it's worth, my current rheumy is young, up-to-date with research, and seems to be pretty smart. She's not the one who put me on MTX or prednisone, but she just happily doubled my pred, so she's obviously not a hater.
Soon, biologics like Enbrel may not require pre authorization for specific conditions. The reason for this is the cost for traditional treatment (all medical procedures) is roughly the same as treatment with a biologic.
Also, people with moderate to severe psoriasis have increased chance of developing a liver condition. This is independent of diabetes, but not independent of obesity.
Biologics overall require less long term lab work than a traditional DMARDs. I’m not saying MTX shouldn’t be used, it’s just outdated.