Immediate Relief? | Arthritis Information

I was diagnosed with Psoriatic Arthritis about 4 weeks ago and have been suffering for about 3 months. It started as pain in my hands in the morning. Then, I looked down one day and noticed that my left ankle was swollen. The swelling traveled up my calf and then into my knee. The swelling in my knee got to the point where I could not walk and I ended up in the hospital 3X until I finally saw a rheumatologist. I've now been on methotrexate 15mg for 3 weeks and take my 4th dose tomorrow. It has not helped yet. I have pain and swelling in my hands, feet, shoulders, and knees. It had been my left knee only, but as of the last few days, my right knee is as swollen as my left was originally. It's hard to limp when both knees are swollen.

Now, I can barely walk. As you all know too well, it's hard to get in to see a rheumatologist on short notice. I see one on Wed (2nd opinion) and my original Dr a week from Wed. In the meantime, is there anything I can do to immediately relieve the massive swelling in my knees, so that I can walk, go to work, get up stairs, etc? I called my primary and he said to hold off to see the RH. Should I just go to the hospital and see if they will give me a steroid injection?

This disease really sucks. Appreciate any help. Thanks!

I'm sorry you're feeling so much pain. I understand. I'm fairly new to the whole thing myself and my symptoms are not well controlled yet. I have gotten some relief from warm compresses and prednisone works fairly well in just a few days. Prednisone has nasty side effects though and everytime I try to cut back my dose I have a bad flare up. You may need to ask for pain meds just to be able to do your daily activities for awhile. I hope this helps. Good luck. Hi and welcome to the forum. MXT may not kick in on it's own and your RD may prescribe a biologic. You can try hot compresses or a moist heating pad, alternate with ice. There's not much you can do till your appt. I know it's disappointing but that's the nature of the disease. Talk to your doctor about an antinflammatory, Enbrel, and possibly Prednisone to get you through this initial onset, also somehting for pain. I'm really sorry that you're having such a tremendous amount of pain. The onset of PsA seems more painful than the recurring flares. Take care and please keep us posted on how you're doing. Lindy LinB2009-08-31 11:57:13I am Ravi chandren from India.First,I am not a Docter and I don't know proper English.But in 12 years research,I discovered and giving one different type of herbal based treatment.No intake medicince.It complete cured all types of Psoriasis,Psoriatic arthritis and all types of Arthritis,minimum 6 days.
Past 5 years in part time I was giving this treatment FREELY to all peoples.Now this was my main work.Now I was giving this treatment FREELY to poor peoples on service basis.More details please contact kamalisethu@yahoo.co.in
please visit www.orthopsoriasiscure.info In 12 years of my research.one separate virus or cells in the huma blood and it over production or multipication thees disease will come(psoriasis,arthritis,Psoriatic arthritis,kidney problem,vericose vein,migrine and some types of Asthma).It affects and multipication to skin PSORIASIS,it affects Lungs,Lungs will became hard and losese its elasticityASTHMA.It affects bone joints,destroyed the lubricating systemARTHRITIS. THERE IS NO CURE for rheumatoid arthritis and the same for psoriatic arthritis. Are the researchers and scientists around the world lying to us? If what you're promoting is a cure why don't the scientists and my doctor know about this cure? Why hasn't this appeared in every medical journal and in every newspaper headline? What a bunch of crap. Please go prey on others. patients(arthritis) taked my treatment and after 5 days gap ,their RF blood test negative.If you want I will send many patients blood reports.Many patients taked my treatment and after all are says this is JESUS gift,this is ALLAH's gift.
I dont no proper English.That is the problem for publisity.
In coming 27 world Psoriasis day,I will speech in Ramachandra medical university.Many medical pharma companie's asked my formula.Last week I was gived treatment one Psoriasis patient from U.S.A.
Sorry, I'm not buying your product or your speech. No matter where you are in the world if you had a cure for rheumatoid arthritis you and your cure would be making headlines around the world. I'd be reading about you in the newspaper and not your self promotion on a forum. Lindy

There is no cure for PSA. Period.

MTX sometimes takes a few weeks to kick in. Give it a chance. I had a rough time with the MTX in the beginning, but once my new rheumatologist told me to take folic acid, the miserable stomach upsets and flu-like symptoms went away. I have been on it for 15 years now. I swear by it. Once it does kick in and the inflammation subsides, make sure to get yourself into a solid exercise regimen. It doesn't have to be at the triathalon level. For me it's just walking at a brisk pace EVERY morning for 30 minutes.

I would like to say, too, that no one but a rheumatologist should be treating you for this disease. I have learned over the years that most physicians who are not rheumatologists are clueless about PSA.

Good luck!

Sam, how do you administer the MTX? This is the first time I've heard of this treatment. I'm meeting with my Rheumatologist on Monday, 10/26 for PsA and am currently waiting on a prescription of Enbrel for plaque psoriasis.....this arthritis is eating me up, I can hardly walk around anymore. Thanks in advance for your reply.

Clint,

Methotrexate can be administered with pills or by injection. Some rheumatologists like to start with the injections for a couple weeks - then move over to the pills. That's what my personal experience was. In either case, it's a once a week dose - always on the same day.

Be prepared to be a bit sluggish for maybe a half day about 48 hours after you take the drug. Not enough to keep you down, but enough to notice that you're fatigued. On the other hand, some people don't experience this at all.

Ironically, I'm one of the few who didn't have signs of skin psoriasis - just the arthritic component. But I've heard from those who DO have the skin component that the MTX also did a great job on clearing the skin.

Word of caution......if you go off this med [as with almost any other arthritic med] the symptoms rebound.

If I could, I would try the Enbrel. My brother is on it and it's been great. My problem is that I was exposed to TB as a kid and Enbrel and some of the other biologics can activate the TB.

Make sure your rheumatologist gives you a TB test BEFORE you start the Enbrel.

I hear you on the "eating me up." Been there. But I'm here to tell you that with these drugs you'll more than likely get your life back. It may take a few weeks - a month? - to kick in, but just hang in there. Really important to exercise regularly.

I want to tell you that even after you've been on the treatment don't think you'll never have a flare-up again. It happens. For me it seems every winter I have a joint or two that flares up in spite of the MTX. I know the signs and I run straight to my orthopedic surgeon and get a cortisone injection to reduce the inflammation. I also make a beeline to the rheumatologist and often we up the dosage of the MTX a tad. It's not the same with everyone. I've noticed that, for me, strep and staph can trigger flare-ups. Therefore, I'm very astute about keeping my hands clean and staying away from people who have contagious diseases.

I failed to mention that some rheumatologists use MTX with Enbrel.

If you do go on MTX then be sure to get an Rx for Folic Acid. [Get it from the pharmacy rather than an OTC supplement.] This will help with any nausea from the MTX which some people experience in the beginning.

Good luck! Let me know the outcome or if you have any other questions.

Sam,

Thanks for the quick reply. I'm 56 & have had plaque psoriasis for 20+ yrs. I've been on Raptiva, then the derm. switched me to Enbrel. Due to my poor health insurance and the cost, I could not afford the 50mg injections 2x/wk. I've been off Enbrel for two yrs. In September I went to my dermatologist & decided the cost associated with fixing the discomfort associated with the plaque psoriasis was worth it & I'm now waiting on my Enbrel injections delivery. My most recent TB test in August was negative.

Last April I noticed stiffness in my feet & ankles after doing my 2 mile treadmill walk....I attributed that to "getting old". After a couple of wks off the treadmill and handfuls of Ibuprofen the discomfort became manageable.

In June I did a three-day fishing trip - it took me three weeks to heal up from that. In August I started a new job which involves a lot of scaffold climbing, stair climbing and working at precarious heights....after six weeks of that daily routine and driving 200 miles/day I knew the soreness I was experiencing was beyond what I expected and it was getting worse. I went to my GP three weeks ago and he said what I described was typical PsA.....he referred me to the Rheumatologist (10/26/09). The prednisone he prescribed to me relieved the fire in my shoulders, elbows, hips, knees, ankles and feet immediately...... it only worked for a few days and the discomfort & plaque psoriasis jumped back on me like a bad suit. I'm currently experiencing a "flare" of which I've not experienced one of this magnitude.

Methotrexate will be something I'll discuss with the doc on Monday, thanks again for your suggestions.Hi Clint and Sam, welcome to the forum. Let us know how your RD appt. goes and I hope that Enbrel is your miracle drug!!! Like Sam, I don't have the skin plaques but do have PsA. I think Sam and I are two of the few. I wanted to let you know that I use injectible MXT weekly. One doesn't usually have stomach issues with the injections and absorption of the drug is a tiny bit better with injections vs. oral. Take care and keep us updated. Lindy

Thanks for the welcome LinB. I doubt I'll find a "miracle" drug, but I'm certain the Enbrel will help. I'm also looking forward to discussing the MXT with the doc on Monday.

About 15 years ago when I started the MTX it was at a 5mg pill dose. I generally tolerate medicines pretty well but this one threw my stomach for a loop. My RD immediately switched me over to the injectable which doesn't affect the stomach as badly. A few years later my work demanded a lot of overseas travel and frankly I didn't want to travel with syringes. So I switched back to the pill and this time my stomach was fine. Still a bit lethargic at the 48 hour point, but pretty good otherwise. Then I had a major flare and the dose was increased and I started having stomach problems again. By this time I was on my 3rd RD who asked me if I was taking my Folic Acid. Huh? What? He was livid when he realized that none of my other RD's ever mentioned Folic Acid.

Bring Folic Acid up to your RD. S/he'll probably recommend that you take 1-2mg Folic Acid daily.

By the way: I personally believe that NO ONE except and RD has any business prescribing Methotrexate. NO ONE.

For what it's worth, I've never been on any form of Pred in the 15 years that I've had PsA. Pred is notorious for triggering infections.

Good stuff, thanks.

"For what it's worth, I've never been on any form of Pred in the 15 years that I've had PsA. Pred is notorious for triggering infections"

Some individuals don't have the need for Pred but there are others that do. Sometimes Pred. is the only drug that will allow you to walk and/or work. Pred. sometimes can be used till the dmards/biologics kick in. Some individuals are bedridden, housebound and unable to work due to inflammation, swelling and pain and Pred. gives them their life back, sort of. Pred. has it's place in the aresenal of drugs that's used to treat RA and PsA.

Now, the use of longterm Pred. is a whole different matter. The side effects are serious and in some instance you have them life long. There are a small percentage of patients that have no response to the meds, irregardless of the combo. For these individuals Pred. is the only drug that will allow them to live a relatively normal life.

Don't discount Pred.. It does have it's place. I think it's given for severe skin psoriasis. It's also a very effective diagnostic tool for individuals who have a negative rheumatoid factor with other negative labs but with all the physical symptoms of RA.

I didn't respond to the meds for 4 years and was on high doses of Pred. during that time and have the side effects to show for it. It allowed me to live a relatively full life until I finally found the right combination of drugs. I was able to work, do my art, lift my grandchildren, hike and golf. I was fortunate in those 4 years because I never had an infection that could be blamed on Pred. I've had a few that have been blamed on MXT and Humira. Luckily, Humira, MXT, Sulfasalzine have done more for me than Pred. It took four years of trying different dmards/biologics, in differing doses till I found a combination that worked well and I could taper off Pred.

It's not a drug that I wish to take again but if it's all I have left to take, I will. Lindy

I need to clarify my earlier statement:

"For what it's worth, I've never been on any form of Pred in the 15 years that I've had PsA. Pred is notorious for triggering infections"

What I meant to write was that:

"I've never been on any form of systemic Prednisone [cortisone]. I have on MANY occasions taken local Kenalog [cortisone] in the joints.*"

* Never more than 2 injections per joint in a given year.

I would think the use of systemic Prednisone [the pills] is contraincated in a person with as many as 3-4 joints flaring at one time. My experience and knowledge from having talked with others is that PCP's have a tendency to overuse systemic Pred. An RD or Orth Surg will use the Kenalog in the joint instead [in the case of about 4 joints flaring concurrently].

This is yet another reason why it's important to have an RD.

Regarding the comment about getting in to see an RD [that it takes so long]: I know this is true in Canada and for those who have the type of insurance that requires a referral to a specialist.

But if you are in the US and do not need a referral, and are already an established patient, there should be no reason why you have to wait so long. Highly regarded RD's have set their schedules up to allow for established patients to come in within 48 hours in the case of a flare because they know that if a PsA patient isn't treated quickly the flare can cause permanent damage. This is true of highly regarded Orthopedic Surgeons who have PsA patients, too.

"I would think the use of systemic Prednisone [the pills] is contraincated in a person with as many as 3-4 joints flaring at one time. My experience and knowledge from having talked with others is that PCP's have a tendency to overuse systemic Pred. An RD or Orth Surg will use the Kenalog in the joint instead [in the case of about 4 joints flaring concurrently]. "

Many of us wish that in a flare we only had 3-4 joints join in the party. A flare can cause each and every one of our joints to have inflammation and swelling thus causing extreme pain from the top of our head to the bottom of our feet. In RA our ribs, jaw joints, back, neck, elbows and each of the small joints in the feet and hands can all be flaring at the same time. This is when Pred. is used. One can't have injections in all of the joints and a one time steroid injection is practically useless when the flare is this extreme.

There are times that none of the dmards and biologics work and Pred. is the only drug that will give relief. You may be correct in your perception that systemic Pred. is overused but in my experience with RA/PsA/OA it's only been used when I have a severe flare and that severe flare lasted for 4 years.

I now have some longterm damage from 4 years of Pred. use but the damage is much more severe from the RA/PsA flare of 4 years. I've never run into an RD that used Pred. indiscriminately, but I'm sure there are some that do.

Like I said earlier Pred. has it's place in treating RA/PsA and all facts should be taken into consideration before starting. Lindy

LinB,

In all respect, why would you continue to use Pred if, as it appears, the flare lasted four years? It sounds to me as though the Pred wasn't working.

I had my appointment with the Rheumatologist yesterday morning. After a good long discussion (with questions generated from suggestions here on this forum) I left with the following:

1. one "in-house" injection of 50mg Enbrel with another I'm to administer on Thursday & two additional weeks dosage (until my supply is rec'd at home).

2. a follow-up appointment in six weeks to see how the Enbrel is working

3. if the Enbrel does not perform as the Doctor expects he'll consider a MTX & folic acid prescription.

Thanks again for your help and suggestions.Hey, Clint,

Sounds great. As I mentioned before, if I could go on Enbrel, I would. Sounds like your doctor is on the right path.....see what the Enbrell does and then have other drugs in the arsenal.

Good luck!

I'm giving myself my 5th injection of Enbrel in the morning. Most of the symptoms of the PsA have become tolerable, plaque psoriasis is beginning to clear. Both legs from the hips down were fully involved with plaques, they're beginning to clear up, lower back and chest is no where near as inflamed as they were three weeks ago........the real discomfort will come later this week when I get my credit card bill from the pharmacy-------I'll cross that bridge when I come to it.

So glad to hear it's working, Clint. That's great news. I'm glad you stuck with it.

Something that everyone should know: While I don't know the specifics, some of the pharmaceuticals have special discounts for the very expensive medications if cost is a problem. It's worth checking into.

Clint, that's great news.

Sam, Pred. used in a flare is to allevite some of the symptoms of a flare. It doesn't stop a flare, only allows one to function on a little higher level. I was on Pred. for 4 years because AP therapy, Enbrel, Humira, Remicade and assorted dmards weren't working. Pred. allowed me to function but didn't stop the flare. A combo of Humira, an increase in MXT and adding Sulfasalazine brought about a dramatic change and I was able to wean off Pred. With RA/PsA it can be a long journey to find the right combination of meds. Lindy

I was diagnosed over 9 years ago, and while in pain of vaying degrees, am able to carry on with my life quite well. It started with swollen feet/ankles and hand pain, then progressed to swelling in hands and knees and then pain in shoulders and legs. As soon as the rhuematologist diagnosed me (after seeing three docs) he gave me a cortisone shot in each shoulder. I had almost immediate relief of about 40% all over. I was also put on meds - methotrexate, plaquinel and an NSAID. They took a few months to start to reduce the symptons further and I still take them after 9 years. I've had periods of time where I've really felt pretty good - good energy, little pain. Other times, not so good, but they pass. I'm not a fan of cortisone (or any med), but those two doses sure helped me, as have the other meds. Most important of all the advice you'll receive is to keep moving. Walk, swim, do pool exercises, even bike. Try to do as much as you did before as possible, even pushing yourself a bit, if neccessary. Sure, rest is very important, but once you stop moving you just get stiffer and stiffer.

Have patience with the meds and don't despair.

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It sounds like you probably have a stress fracture or possibly an infection in your knee. Did the ER docs draw any fluid out of your knee or take x-rays?

You need to go see an orthopedic surgeon