Severe PsA Pain

Hi all, i have been living with this for about 12 years. I'm 37 and until recently i was doing ok. Recently stopped getting relief from the Sulfasalazine I was taking, so my specialist prescribed me Methatrexate (think thats the spelling).

However i am now in so much pain i am having to take time off work. Cant move properly, cant sleep, cant even hold a tea cup!!

My specialist says this medication takes months to build up in your system, but surly not at the expence of your quality of life.

Can anybody tell me how long i should feel like this (started meds in December) . And also, is there something i can do to relieve the pain in the meantime? I have all the usual, co-codamol, paracetamol, ibuprofen etc.

Any advise/help would really be appreciated.



I think everyone has a different experience on how quickly the meds take to work. I discovered that my Rheumy books my appointments at 3-4 month intervals and rarely wants to discuss changes until she sees me again as most of the meds take that long to work. I also discovered that feeling better crept on me the same as the disease crept up on me. I have been taking methatrexate or mtx for a number of years both injectable and oral. I found it did not do much until I was above 12.5 mg and had to start injecting that amount as the side effects with the oral form at higher doses are really tough. I exercise in a heated program pool 88-92 degrees, soak in a hot tub at the gym and hot epsom salt soaks at home. I use splints and Salonpas topical pads, sold over the counter in pharmacies, Costco and Walmart. I use elbow wraps that have gel pads in them that put pressure on my tendons that really hurt, sometimes called golfer's and tennis elbow. I use paraffin dunks for my hands and support hose for my legs. When I sit I elevate my legs to cut down on the swelling in my feet. I walk with a cane. I have found lots of things that help but nothing takes it all away. Oh and I forgot I love my generic Tempopedic mattress from Costco! It has made a big difference. I hope all this helps to make you more comfortable until your Rheumy and you find the right combination of medications.

Can you doctor prescribe prednisone for short-term use to reduce the inflammation?

Ditto what Frances said. It sounds like you are flaring, and prednisone can help bridge the gap until a new medication starts working.

Frances said:

Can you doctor prescribe prednisone for short-term use to reduce the inflammation?

I see that you're in the UK... socialized medicine... gotta love it!

Yes, MTX can take awhile to show results but the biologics (Enbrel, Humira, Remicade, Simponi) do tons better and quicker. The difference between socialized medicine and well... good health care is how long you have stay on MTX before the doctor will put you on something better. I was on Enbrel in one month. My doc didn't even give MTX enough time to fully work. There's a protocol your doctor is following and you can ask how much time you have to give the MTX before you can use a medicine that works.

MTX possibly least it does anecdotally, but the effect isn't strong enough to be proven in clinical trials. The biologics on the other hand are all effective enough to plass clinical trials. Basically your doctor has NO evididence that MTX works other than observing patients. If I was in your position I would be pushing hard to get on a biologic sooner rather than later. You don't want your joints falling apart.

Sorry to hear you have to deal with such pain! I agree that a prednisone burst might help, or even low dose pred until the mtx is helping.

Thanks for all your advice and response was back at doctors today and was advised to give the mtx a few more weeks to start working dont see my

Rheumey doc for another 3 weeks so will ask him about this other medication although he did mention it would be hard to prescribe due to cost downside of nhs! Have been prescribed stronger painkillers in the meantime andbought a heat lamp am willing to try anything

Prednisone is VERY inexpensive.

Prednisone cheap as chips on NHS so ask for a quick injection (or tablets but injection means you don’t have to pay for prescription!). The relief is great and gives chance for mtx to kick in.

The biologics are expensive and that's why they're hard to prescribe. But that's shortsighted. The medical cost of the complications of PsA are more expensive. Even more expensive than that is having able-bodied citizens become disabled. The $20,000 per year looks cheap compared the cost of having you become disabled. Prednisone isn't a good long term option. You may have to fight to get the appropriate treatment.

I have been on methotrexate many times in the past. I have had the pills and the injection. It always worked very well for me. You could try a daily anti-inflamatory or a course of prednisone. If that doesn't work you could try pain medication.