@BeautifulBirds
Is methotrexate still used for arthritis pain?
It's the Gold Standard DMARD. You don't get through the NICE rules for
something better that doesn't make you chuck your guts up and lose so much hair you look motheaten unless you've been on it.
As you can tell, I don't recall that stage of the pathway six fucking years with much fondness.
Biologics and steroids though - they're great. OK, if you don't wait long enough for the alcohol swab to evaporate or for the biologic to reach room temperature before you inject, Cosentyx in particular stings like a bitch/a very angry wasp that has superglue smeared on its arse so it can't fly away, plus the needle gauge is larger and the volume you're injecting is much higher, but it's the first time since I was about five that I have got to wake up in the morning and not be in pain from the moment before I open my eyes.
Intraarticular steroids are an absolutely breathtaking cunt until the local takes effect in there where you're slowly blowing out air as though you're in labour through it, mentally telling yourself DON'T MOVE DON'T MOVE FUCK DON'T MOVE (im ones are fine, though), but they work, too. Just a pity that you can't have too many of them because they can also permanently damage joints and tendons and make you so vulnerable to infection and life threatening discontinuation if you've got a cheapskate doctor who only gives you oral ones.
That's the real fucker with my PsA, though; so many buggered tendons. Just had an MRI of my hip to check that it is just more tendon buggerage and not anything else screwing over my hip/lower spine/SI joint, a scan of my shoulder where to go with the damage to the AC joint from uncontrolled inflammation, I've also got a supraspinatus tendon tear that won't heal and has to proceed to full rupture before I can have everything pulled out, fucked up permanently and they might chop off the end portion of my collarbone whilst they're at it if I'm lucky. Then there is the permanent damage to my Achilles on both sides. And the plantar fascia. And the flexor. And the other shoulder. You can replace joints once the inflammation is calmed down - there's not the same with tendons. And the back pain - they're hoping the MRI won't show signs of fusion because it's brutal and high risk surgery with poor results for many.
Oh, and let's not forget that my father dropped dead aged 54 with cardiomyopathy as a result of his being untreated. And my brother in law has terminal brain cancer as a result of the biologics he took. And his daughter had heart failure aged 37 due to inflammation affecting that rather than her joints, only diagnosed when she collapsed at work and had to have CPR all the way into resus. Other people have died due to liver damage or infection from their immune system becoming too depressed, which is why you have just so many blood tests.
So if you do take stuff, you can die early as a result of taking it. But if you don't take anything, you can die early as a result of not taking it.
Not forgetting that sometimes your immune system gets bored with just going for your joints or tendons and decides to have a go at your eyes, gums, heart, gut, skin or your brain - you can feel terrible, in tears, not sleeping, not being able to rest, have suicidal ideation, but not be actually depressed in the slightest just because the inflammation is fucking up your head. Antidepressants are dangerous then, as it's like doing a shedload of Ecstasy - they just can't help because it's inflammation, not depression. Get the disease activity down and irrespective of pain, you're absolutely fine mentally. Because it's inflammation, not depression, not pain.
But yet we still have muppets on here saying it's all arthritis/wear and tear. No, it really, really isn't. It's a systemic disease that kills and steals lives from the smallest of children and apparently healthy adults.