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Finding the right treatment to keep your psoriatic arthritis under control can take time. The first, second, or even third may not work for managing your particular condition.

Treatment change would come about in two different situations for psoriatic arthritis, says Reshma Marri-Gottam, MD, a rheumatologist at St. John Providence health system in Detroit. One would be theyre not tolerating the medication or they have an adverse effect or reaction to the medication, or the risk outweighs the benefits. The other is theyre just not responding to the medication.

It may be that your body has built up a resistance to one drug or that the disease itself is ramping up, especially if youve only been managing the symptoms rather than the source of the symptoms.

Usually we are adjusting medications due to active joint inflammation and active skin disease, explains Kelly Weselman, MD, a rheumatologist at Wellstar Rheumatology in Atlanta and chair of the American College of Rheumatology communications and marketing committee. Sometimes we change a medication because it is not effective at all, she says. Sometimes the medication shows partial benefit, but the patient and I might decide we can do better with an alternative medication strategy.

The right treatment plan can make all the difference in controlling your symptoms and allowing you to continue your daily activities.

Although this is not a curable disease, it can often be put into remission, Dr. Weselman says. There are certainly patients who we just cannot get into complete remission, but usually we can find a treatment regimen that improves their quality of life.

Here are the questions you should ask to determine whether its time to change treatment and what to expect.

Every drug comes with side effects and risks, and these can be the reason some patients want to stop taking a drug. The most important thing is to be open with your doctor about what you can and cannot handle.

Be honest with your physician about ongoing symptoms that are bothersome. Your appointment is the best time to discuss changes, so arrive prepared, Weselman says. Recognize that every treatment carries some degree of risk, and lack of appropriate treatment also carries risk. Many decisions must be made in person, either due to a need for the doctor to examine a particular area or to have effective discussions about the available options.

I explain to patients our ladder of treatment options as well as the risks, benefits, and potency of each agent, Weselman says. We discuss costs as well.The options are finite, so we need to discuss all options to avoid running out of treatments.

The first drug most people use to treat psoriatic arthritis is a nonsteroidal anti-inflammatory drug (NSAID). These over-the-counter drugs, such as ibuprofen(Advil, Motrin) or naproxen(Aleve), treat the pain and inflammation but not the underlying cause of the disease.

The next step up from NSAIDs are disease-modifying anti-rheumatic drugs (DMARDs). These drugs, such as methotrexate, do not actually modify psoriatic arthritis disease but can prevent its progression.

Biologics, which are made from living organisms, work by targeting specific proteins or cells in the immune system.

Patients may receive a temporary course of corticosteroids during any of their treatment plans to stop a particularly bad flare-up.

We discuss guidelines in treatment and standards of care and how that applies to their specific situation, Weselman says. Spending a few minutes giving the patient information helps us to make decisions together.

Its only human to want instant relief, but some drugs take time to really kick in. Weselman and Dr. Marri-Gottam recommend allowing three months for a new medication to begin working.

It can be frustrating for patients waiting to see if a medication is effective, but if we give up on a treatment too quickly, we risk losing potentially effective treatments, Weselman says.

The most current framework for thinking about psoriatic arthritis treatment today is that combination therapy is better than monotherapy, Marri-Gottam says. That means that using two drugs simultaneously can often achieve better results than just one.

Usually methotrexate is combined with a biologic agent, Weselman says.Sometimes sulfasalazine is a part of the combination.

Sometimes doctors have to try one treatment before another simply to make sure you dont end up paying out of pocket.

We tend to use the medications that have been out on the market the longest, and we try to do what we think is right for the patient. But sometimes the insurance company dictates what we can and cant use, Marri-Gottam says.

One company might require a patient to try adalimumab(Humira) before etancercept(Embrel), for example; while another company may require a different protocol. Insurance companies often require patients try a DMARD before moving on to biologics.

Methotrexate is the first med I usually start with, even if theyre a good candidate for a biologic, Marri-Gottam says. With DMARDs, if theres any dose changes that can happen, you try to give a fair chance to that medication before you say, Hey, this isnt going to work anymore.

Some drugs restrict the activities you can engage in or delay goals you may want to achieve, such as starting a family. Its important to discuss with your doctor what youre willing to do and give up.

Younger patients should definitely think about whether they want to have kids, Marri-Gottam says. I advise patients that they need to be on birth control if taking methotrexate because it is known to be harmful to the fetus.

Not enough data exists about biologics to know if they can cause harm, so its currently recommended not to take biologics while pregnant or trying to conceive either.

Alcohol is another big one for methotrexate, Marri-Gottam says. If youre on methotrexate, you shouldnt drink at all. Methotrexate is heavy on the liver, so if youre taking that and drinking alcohol, which is processed by the liver, its too much for the liver to handle for some patients.

Go here to read the rest:
6 Things You Need to Know About Switching Psoriatic Arthritis Treatments - Everyday Health (blog)

This entry was posted on February 18, 2017 at 12:41 pm and is filed under Arthritis. You can follow any responses to this entry through the RSS 2.0 feed. Both comments and pings are currently closed. |