What are the alternatives to plaquenil for psoriatic arthritis? I have been on 2 x 200 mg for almost ten years, and the eye doctor has concerns that is has started to damage my eyes. I also take an injection of methotrexate once weekly (.9 ml I think).

Developed Trigger Thumb (locked extended) treated with cortisone shot, told to see rheumatologist since they feel I have PA not RA like I was told 35 yrs ago. Have in past used, Indocid, then Entrophen, then ASA as I felt need if I had a flare. this last flare lasted 3-4 months and was worse than any I’ve had for many years(just went away a week ago and now i feel good), but unsure if this trigger thumb requires further treatment, ie surgery, since I’m told this cortisone shot will wear off before long (had it May 4th). What more help can a rheumotologist do for me? What should I ask surgeon about thumb…since one surgeon said too many risks to do surgery on me, and second surgeon said, definitely need surgery, I’m 53, excellent health 9except for RA or PA, no meds, appropriate weight. Want proper use of thumb with no possible recurrences. Gladys

Enbrel and Humira causing extreme fatigue. A couple of years ago I started on Enbrel weekly after my first psoriatic athritis flare-up. I found that, while it did dramatically reduce pain and inflammation I experienced overwhelming fatigue and weakness.(Without it/prior to Enbrel I would suffer a 7-8/10 on the pain scale, even after taking the max daily dose of Tylenol and Celebrex.) If there were an equivalent of the pain scale for fatigue, I would place myself at (9-10)/10 for the first 48 hours. (E.g. Found it difficult to sit up, breathing was somewhat labored; I was essentially incapacitated.) The weakness would start roughly 8 hrs after the injection and very gradually subside over the course of 5 days. During this time the pain gradually returned (to peak at 8/10 on the 7th day just prior to my next shot), with the net effect that I was essentially dehabilitated for the entire week. Early this year, at my urging, my doctor switched me to Humira (1 injection every 2 wks). Initially, I was relieved that I had less fatigue, but after 5 mo. I have found that Humira follows essentially the same pattern, except that it has a much milder impact (i.e. milder fatigue just after the shot, but also much less pain and inflammation reduction). TNF-alpha blockers are ideally supposed to increase energy; why would they dramatically reduce it? Thank you.

I have been taking Enbrel for several years (50mg every week) but recently has stopped being effective to address my psoriatic arthritis.  My doctor recommended increasing the dose to 100mg a week or switching to Humira.  He believes that my overweight condition is not allowing the Enbrel to be successful.  Any recomendations between Enbrel and Humira?

I have suffered for the last 5 years from some unknown spondyloarthropathy – possibly ankylosing spondylitis. I’ve never received a definitive diagnosis from my rheumatologist; he’s just slowly eliminated the possibility of other diseases through testing. One of the symptoms that is most pronounced on me is oedema above and below all my major joints (knees especially). He has said that this is enthesopathy – inflammation at the point where ligaments and tendons attach to bone. Although I am greatful that I do not eroded or swollen joints, this inflammation of the tendons and ligaments is no less painful. The joints themselves do ache at times, but are not red or swollen. My concern now is that these attachment points could begin to erode the bone and cause deformity. My question is: Is this enthesopathy a symptom of AS? Should I be concerned about ankylosing joints – is this the beginning of the ankylosing process? My hips and shoulders have already lost some range of motion, is my spine next? I can already hearing the “popping” noise in my spine upon movement, that I usually in hear in my other joints. Is this noise actually the inflamed tendon sheaths? And is that what is causing the soft tissue swelling around the joints? And finally, what can be done to slow this process (over the short term to reduce the swelling and over the long term to prevent deformity)?