It has been a few months now living with and learning to accept life with Psoriatic Arthritis. To be honest, it hasn’t been easy. If you recall from my first post on my diagnosis and first steps for treatment, I was prescribed a few medications to halt the advancement of the destruction of my joints and tendons. My doctor prescribed the following:
- steroids for inflammation
- folic acid
I prepared to take the methotrexate on Friday nights planning to recouperate from any side effects during the weekend. (Sounds fun, huh.)
So How Did it Go?
I will admit, I was pretty nervous the first week. After doing my research I was prepared for all the potential side effects: fatigue, nausea, stomach upset, hair loss, mouth sores, dry eyes (and on and on…). I took them at night hoping to sleep through the worst of it. The next morning I woke thinking I was pretty lucky- just mild nausea and quite a bit of fatigue. As the weeks went by and the medicine began to build up in my system, the side effects started to get worse. That along with the pain, inflammation, and fatigue that came with the disease itself began to take its toll. I began to feel like I had a bad flu for about 4-5 days after I took the methotrexate and began to feel better just in time to take the next weeks dose.
Over the 5 weeks, I continued to work and (ahem) attempt to keep up with the kiddos and housework. Darling Hubby was saddled with more than his fair share of house duties and I felt very stressed trying to manage and continue life as normal. One of the hardest parts of this disease is the effect of stress. Stress is like fanning an already raging fire for autoimmune diseases and while I am typically very good at managing stress I have had to learn to say “no” more than I would like to in an attempt to keep things in check and set my own limitations for my own good.
What’s the New Plan? What are my new treatment options?
At six weeks, I returned to the doctor to evaluate my progress. At this point, pain and inflammation that originally started in my hands and feet has progressed to both elbows and shoulders as well as my back and hips. After talking with me and performing another evaluation, my doctor decided that methotrexate wasn’t working well enough for me and my body wasn’t tolerating it very well. So now it is time to move on to try biologics in conjunction with another drug, similar to methotrexate, called leflunomide. We discussed a number of options:
- Enbrel– a biologic medicine that I would have to inject myself with 1-2 times a week with little leeway in changes in dosage and high risk for injection site reactions. You probably have seen commercials for this one.
- Remicade Infusion– this biologic is administered through IV in the doctor’s office. After the two starter doses within two weeks of each other, I would have to return every 6-8 weeks for each new infusion of the medication. Dosage can be easily increased and monitored as needed by my doctor. Both medicines require blood work but this one also requires a chest x-ray.
After discussing the pros and cons of each option and the recommendation of my doctor, we decided to go with Remicade. My doctor warned me that it will take a few weeks to be able to start Remicade because it requires special authorization from insurance. After another steroid shot, I was sent on my way with our new plan to take leflunomide daily, along with folic acid, meloxicam, and Remicade as soon as possible. Fingers crossed that this combination works to put my disease into remission!
Until then, I sincerely hope that those in my life, my friends, family, a co-workers can be understanding and supportive as I have to make many hard decisions about where my energy, time, and efforts are used. I’m sure many may not understand that sometimes I have to say no. That it is hard for me to set limitations and often feel like no matter what, I’m letting someone, especially myself down. But decisions have to be made and I only have so much to give, at least for right now.
Until next time, keep smiling and take the time to love each other every Sunday.