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Diagnosed yesterday

Hi - I have been to a derm and 2 Rheums and was finally diagnosed yesterday w/PsA. I have the HL27 marker, and some joint damage in my feet and sacroiliac joints. The Rheum wants to start me on methotrexate and a biologic at the same time. He wasn't very good at discussing my concerns re: side effects and didn't give me info on why 2 drugs to start.

Concerns with treatment plan


I'm seeking a second opinion because don't feel like I have enough info to start this kind of drug regiment right off the bat. Is this normal to start w/both drugs? And aren't there dangerous potential side effects from methotrexate? In addition, he said I have osteopenia, or pre-osteoprosis and wants me to take Reclast for that. Anyone have any experience? I am a person who is hard-pressed to take and Advil, so all of this is a bit overwhelming. I spent yesterday in tears.

  1. Bless you, @jeejee. Wish I could give you a big (but gentle!) hug! I ended up in tears after being prescribed medication too. It is a LOT to take in. I am really sorry to hear that your rheumatologist was not forthcoming with information or addressing your concerns. I hope you'll get an opportunity to discuss your concerns with either your current or a new rheumatologist, and ask any questions that you need to. Will you let us know how you get on with getting a second opinion?

    Unfortunately all medications have potential side effects, but that doesn't mean that you will get any/all of them. We're all so very different. I am taking methotrexate and so far I personally have just had mild nausea, but I know others have had quite a rough time with it. It would be great if there was a way to know how you'd respond/react to a medication before taking it ! Feel free to browse the forums/Q&A section for different experiences on this.

    With regards to prescribing both the biologic and the methotrexate together, my understanding is that methotrexate can increase the effectiveness of some biologics, and it can also help prevent the body from developing antibodies to the biologic. When more than one treatment is used at the same time, this is called "combination therapy". We have a little information on this within this article: https://psoriatic-arthritis.com/treatment/

    I hope that this is of some help. We're here for you! How are you feeling today? <3

    -Catherine, Community Moderator

    1. Hello. So I have been to a dermatologist for my psoriasis. I am feeling like I have PSA. Can you all please help me with what are the first signs of this you noticed? Months ago I had my right hand fingers swell so bad and hurt so much I couldn’t even make a fist. Every morning when I get out of bed I can barely walk bc my feet hurt so bad. My legs and knees just ache and ache at night. Any help with this would be much appreciated. What are my next steps so this doesn’t get worse?

      1. If you have developed psoriasis, then you would be at risk for also developing arthritis. The first thing you should do is get your GP to look over your symptoms, get some blood work done to look for certain inflammatory markers like elevated CRP and ESR, along with rheumatoid factor, HLA-B27, various other screening tests and most importantly get referred to a rheumatologist as soon as possible.

        The swelling fingers are often called "sausage digits" or dactylitis and are a hallmark symptom of PSA.

        Having said that, before you jump to conclusions, it's important to get properly diagnosed. The sooner you come to a diagnostic conclusion, the sooner you can start getting proper treatment and prevent any potential long-term damage to your joints. For many people, including myself, treatments can get you back to an acceptable standard of living.

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