Methotrexate for Psoriatic Arthritis Treatment

Question

I am 20 years old and have been diagnosed with psoriatic arthritis for the last two years. I developed psoriasis when I was about 11. My main problems are in my knees and pelvis but recently I have started to feel more and more pain in my wrists and ankles. I am currently injecting 15mg of methotrexate a week, taking tramadol at night and 150mg of diclofenac a day. I feel like things are getting worse. My doctor suggested switching the diclofenac to celebrex but I’m not sure that’s the best solution. I’ve been on methotrexate for six months – at first it was working really well but now my periods of stiffness in the morning are much worse and I’m constantly in some kind of discomfort. Can anyone suggest anything? I feel unable to tackle my rheumatologist who seems to think I should just plod along as I am.

Answer

Methotrexate is certainly used in treating psoriatic arthritis.  As is the case in rheumatoid arthritis doses ranging up to 20-25 mg/week may be required and it may take a couple of months until the benefits of and increased dose are felt.  If there is ongoing inflammation in the joints in spite of MTX, the group of medications called TNF antagonists are often used (Enbrel, Humira, Remicade). For reasons that are not well understood, some patients will feel more benefit from a change from one NSAID to another as your rheumatologist has recommended (diclofenac to celebrex).

Clifton Bingham, III, MD

About Clifton Bingham, III, MD

Associate Professor of Medicine
Director - Johns Hopkins Arthritis Center