I need a plan B...

[mataribot]

So sorry to hear that has caused a flare. We all need a plan B. That's a good way to put it!

I have PsA and Duprytrends Contraction and the flare factor is very high treating my hands and feet. I also have  palmoplanter P. Which makes treatment so unpredictable .

I take Apremilast for my PSA. also Celebrex for years even before celebrex at one time was removed from the market . Then the added warnings now listed on the drug packet it was put back on the market.My doc advised to take it again. It really helps with the combo of drugs. All in all everyone is different.

Anthralin is one of the original psoriasis topical medications. Years ago, generic anthralin paste was applied thickly to plaques of psoriasis and then dusted with a powder.  A form of occlusion. In Australia it's still done in hospitals. As a child I was in the hospital many times covered head to toe with P. treated with Anthralin along with light treatment.

I don't know if you have tried this. The treatment was effective. My mom learned the method then passed it on to me. Many  psoriasis therapies have generally fallen to the wayside in favor of the more new drugs & treatments as most just want to take a pill.

I still use it along with my arsenal of natural creams and topicals like coal tar and my ever handy occlusion method. Occlusion starves the p. Layers by shutting down the small capillarity arteries that feed the P. Layers deep in the derm cells thru the many layers. So it shuts the TNF or Interluken factor off from the outside. Some will argue the point that occlusion is work and takes time. It has worked for me for many years. It's will not help PSA.

Everyone is different so the best thing I can advise is study the meds on the market ask your doc about them and try them. Eventually you will find a combo that works for you! Fred has listed all the drugs on this forum.
Have a good Day !!!!

Thanks for the detailed reply. I keep myself informed about Psoriasis and related topics. The definition PsA is vague and can be split into two groups: primarly axial and primarly peripheral disease. DMARDS have shown some efficacy in those with peripheral, but none (besides sulphalazaine) in axial disease. The only drugs to show any significant efficacy in axial disease is biologics (TNFs). You can add Otezla to the pile of drugs that doesn't work for axial symptoms. My disease is primarily axial; the only DMARDS that are worth taking is one that can added on top of the Cimzia for psoriasis. That is plan A. Plan B is trying another drug.

While it maybe true that NSAIDs may slow down or prevent bone damage in those in with axial disease, they also are known for making the pain caused by inflammation of tendon insertions worse and have even been cited in causing damage. The primary offender is Celebrex. Also, NSAID may also cause drug induced Psoriasis. NSAIDs do help with pain, but narcotics seem to better for OA caused by poorly controlled disease.