After an initial wobble about a missing blood test my consultant decided now was the time for action. The clinical data indicate inflammatory arthritis and the lab test results help to rule out other candidates. What type of arthritis? In order of the most likely first: psoriatic, rheumatoid, ankylosing spondylitis, reactive. For the first three, an exact diagnosis doesn't matter too much since treatment is identical - a DMARD such as methotrexate or sulfasalazine.
Memorable quotes:
'with methotrexate, we don't like you drinking'
'so you've read the background literature on methotrexate side effects and it's probably scared the hell out of you'
My notes before the consultation:
U/S fingers?
What is the diagnosis? Level of confidence?
Could this be reactive arthritis?
What is the best way to reduce the inflammation in the short term?
What is the best way to arrest the disease?
What is the therapeutic target?
If this is psoriatic arthritis, what is the likelihood of me developing skin psoriasis?
Treatment plan?
Options
- course of NSAIDs
- injection of corticosteroid, prof speed mentioned MRI scan would indicate my knees are a good candidate
- lance cyst to remove synovial fluid
- surgical removal of cyst
- mono-therapy with DMARD
- combined therapy
Which is the most effective combination of DMARDs for PsA?
- anti-TNF, biologics, e.g. Enbrel (etanercept), Humira (adalimumab), Remicade (infliximab) and Simponi (golimumab)
Is methotrexate effective?
What are the long-term risks associated with DMARDs?
What are the side effects? See NHS website
Strategy: start from a low dose and increase until improvement in condition, or start with high dose to trigger change?
What exercises might be beneficial?
Symptoms 21/9/14
Fingers on left hand stiff will not fully straighten or close
Stiffness in shoulders and upper spine
Knees very stiff - difficult to get up from sitting position. Often click, sometimes painfully
No comments:
Post a Comment