Advice needed about DMARDs

[jiml]

Jim it makes no difference whatsoever if it's used in Germany or anywhere if it's not used in the UK for psoriatic arthritis. It also makes no difference what you think about increasing the dose, as it's not going to happen. You have to remember that each country has their own protocol when it comes to treatment, we may not like it but they are rules that they have put in place and a doctor has to abide by those rules.

Fumaderm (even though the DMF gang don't like it) is not widely used in the UK and you are not going to change it. You may think it's "pathetic", "it sucks", "the dermatologist is blindfolded", "frustratingly silly" and you may even feel like writing to a German doctor about it. But you live in and are being treated by the NHS.

I say you have to get over it as it's the way it is in your country. It's not available here, so we try other things.

Sorry but I do really think you should forget about going against your doctor as their hands are tied. I would say either put up with it the way it is on Fumaderm (that would be my choice if I were you) or move on to a Bio which will soon sort you out.

Also dump the rheumatologist and just deal with the dermatologist. And stop trying to work a way around their protocol it aint gonna work.  

Fred runs off before getting beaten up by the DMF gang.  

Nooo I'm not going to even disagree with you Fred and it looks as if you are right, but I will have one more shot in August at the dermatologist and then I will let it go .....Ive not been offered any biologicals if I had I might go along with it

Don't run off all opinions are welcomed by me  

Thanks Fred and all for suggestions they have all helped me in my discussion

Well yesterday afternoon I went to my  appointment with the Rheumatology nursing practitioner who to be honest spent more time than I deserved with me. She has been in rheumatology for years and is passionate about treatments and we spent a long time discussing the various treatments, she has ruled out biologicals as I have to try salfasulfazine or leflunomide or methotrexate before being considered for biologicals. I learnt a lot from her and have a lot of respect for her and the amount she knew

I explained my position that I had a good drug that works excellently on my psoriasis and that I am reluctant to give it up for fear of my psoriasis returning. I said I was quite prepared to try something but that I was keen to see if Fumaderm at a higher dose could work for me.

I had been to the dermatologist earlier in the week and he wrote to rheumatology saying if they agreed he would up my dose ......as my bloods were good lymphocytes were 1.35 and all other functions were good

She has agreed to go with my suggestion and for me to go and see her again in 3 months and we can assess the arthritis again and if there is no sign of improvement or the scans show further erosion of the joints, I feel I will have no option other than to try leflunomide as she was keen to halt the deterioration