Which drugs are having the best result?
I have been on Humira and Methotrexate for the past two years via the VA. I am still having problems and my fingers are now getting very stiff. I do exercises and I knit and crochet. I am an active 77 year old. Active meaning I walk with my dog 4 or 5 times a day. My question would be is there any newer drugs that are working for us older folks that may help keep me upright? I have degenerative disc disease so if I am not able to keep the progression from getting worse I know I will be put in a wheel chair. I had rotator cuff surgery last october and I wasn't allowed to do any strenuous exercise for 5 months. I need my core muscles. I also have Psoriasis and that is currently flaring as well.
Unfortunately, there is no one medicine that is "the best" for this disease. What works for one may not work for others. There is no magic bullet. I, too, get my care through a VAMC, and the process for getting some of these meds approved can be cumbersome at times. However, I've found that once a medicine has met the threshold for failure, the VA has been pretty receptive to my rheumatologists' requests to transition me to a different medication. That being said, you will have to try, and fail, the different variety of medications in order before being approved for a new one. It sounds as though the Humira/Methotrexate combo isn't as efficacious as hoped, so your rheumatologist should put in for approval for a new medication. That could be another tnf-A blocker like Enbrel, or an IL-17 inhibitor like Taltz, or even a PDE4 inhibitor like apremilast. And your rheumy may keep you on Methotrexate concomitant with a new biologic in order to slow down immunogenicity, your body's development of antibodies to the biologic drug. Additionally, you can have your doctor put in referral to physical therapy or rehabilitative medicine. I would also advise you, due to your age and the nature of this disease, to have your PCP put in a consult for endocrinology to have a bone mineral density scan and labs done to check for osteoporosis, because it is a thing with PsA. The VA system has a multitude of resources available to you, but you will have to navigate some twists and turns from time to time, as I'm sure you know. But priority one right now should be for you to get RX'd a different biologic, and then wait to see how it works. And it shouldn't take months and months; if a biologic is going to work, you should feel some difference within a matter of weeks.
