Please provide me with information about psoriatic arthritis and pain controlPlease provide me with information about psoriatic arthritis and pain control

The current medical treatments do not address aberrant genetic signaling problems that include MHC and dendrytic cells. I am concerned about the toxic effects of Methotrexate which causes WBC suppression, depletion of folate and potential for hepatic, cardiac, and pulmonary complications as well as a risk of non-Hodgkin's lymphoma. The fatigue is debilitating and I have headaches every day.How can I alleviate the pain? It is also debilitating. I can't take NSAID's due to a hx of gastritis. Acetaminophen doesn't help and is toxic to the liver. I have considered an intrathecal pump for opiate administration or a fentanyl patch. Do rheumatologists prescribe these treatments? Do have any suggestions for pain relief other than steroids which cause fluid retention and hypergylcemia? thank you Nina

Answers from our Doctors

Dr. Mary-Ann Fitzcharles says:

Thank you for your questions.

1. The main focus of treatment for any inflammatory arthritis, which includes psoriatic arthritis, is to control the inflammatory process as best as possible. You have raised concerns regarding methotrexate. To begin with, we need to acknowledge that any medication will be associated with some adverse effects, but these do not necessarily occur universally in all patients treated with a drug. We have at least a 20 year history of methotrexate use in rheumatology patients and it is currently the most commonly used drug to treat inflammatory conditions in both adults as well as children. We therefore have an excellent experience with this agent, understand the risks and know how to appropriately follow patients. Over the years, we have been pleasantly surprised by the good tolerance of this agent.
2. Pain due to any cause has important negative effects on well being and we believe should be controlled as best as possible. There is no gold standard for pain relief, but the reasonable way is to progress in a stepwise fashion. Opioids and especially intrathecal opioids are very much at the top of the scale. I am sure that your physician will consider some of the other pain relieving medications such as the tramadol products, mild opioids such as codeine, or even buprenophine. We are also beginning to consider the use of adjuvant analgesics in joint pain, such as the gabapentinoids, or even some of the antidepressants that may have analgesic properties. Topical agents, such as nonsteroidal antiinflammatory drugs, applied in a cream have shown some effect on joint pain.

With Thanks,
Mary-Ann Fitzcharles

Answered on: Wednesday, September 22, 2010 - 13:22

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