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PsA Is A Full Sink?

  • By Sean

    So my Humira ambassador called me yesterday to see if my second injection went okay (it did) and we had an interesting conversation. I’ve ZERO idea of the scientific validity of this but it’s a perspective on PsA and RA I’d never heard before.

    The conversation began as I was talking to him about my mother’s experience with RA and Remicaid. She was on the drug for about four years. She took herself off of it because she thought she was getting too many UTIs. (Although she now thinks those were the result of age, not of the biologic.) Anyway, after she went off of it she had YEARS before her RA symptoms returned. Years or no symptoms without being on a biologic. That’s when Doug (a nurse who specializes in biologics) told me the sink theory.

    PsA or RA, he said, is like a sink that’s backed up. Once it fills up and begins to spill over is when your immune system begins attacking your own body. Biologics like Humira allow the sink to drain.

    Where it gets tricky is that each person has a different size sink that fills at a different rate. So one person’s symptoms may return the next month after going off the biologic. For another it could be years.

    In my case I COULD potentially be one of the lucky ones for several reasons. One is hereditary (my mother’s success going off of her biologic). Another is that I developed PsA later in life compared to when most people have their first noticeable symptoms. And the third is my blood work, which is all in the standard range.

    It will be some time before I have the opportunity to test the sink theory but I thought I’d pass it along because it’s a perspective on our condition that I’d never heard before. And it gives me hope that a biologic isn’t something I necessarily have to be on for the rest of my life.

  • By VickiN Moderator

    Thanks for sharing this, Sean! I’ve heard of the sink theory too and I think it does a good job of helping to explain why for most of us it’s a combination of genetic and environmental factors. If you look at identical twins, they don’t always develop the same condition even though their genetics are the same. It makes sense that there’s a certain threshold (or sink) that needs to be crossed first (or filled) before the symptoms appear.
    -Victoria, Community Moderator

  • By Sean

    It helps in understanding the condition but it also fills me with hope.

    Going on a biologic is a big step. But if it’s something I can be on temporarily and then go off of potentially for years without my symptoms returning, then it doesn’t seem quite as daunting.

    There are no guarantees of that, of course, but I like look for positives.

  • By TamP

    Very Interesting this theory
    Thanks Sean

  • By Sean

    I don’t know the validity of how much PsA is or is not like a sink but I think it’s pretty well documented at this point that some people can go years after going off of a biologic without their symptoms returning.

    As for whether or not anyone has ever gone into permanent remission (and how many years would be required for the remission to be considered “permanent”) I don’t know.

  • By MaryG

    I was diagnosed in 1980. I have tried almost everything. Enbrel is the only thing that has ever worked. I have been on it for years and had little pain and my psoriasis completely clear. Then due to insurance I was not able to afford it. Within just a couple of months it all came back .
    Once I went back on it. All was good again. Everyone is different.