Mother with severe psoriatic arthritis

Question  Dr., My mother is a 57 yr. old who was diagnosed some 14-15 years ago with psoriatic arthritis. She has been thru literally every treatment available. Light treatments, cyclosporine, celebrex, embrel, topical steroid cream...she has been taking methotrexate, intravenous & oral for years, at very high doses. Which help short term. She has been having intravenous remicade treatments,and again, initially with results. My mother has used numerous pain medicines, lately a pain patch. Which has provided short term relief. She again is in a bad flare up, with constant pain & fatigue, right now bed ridden. She was prescribed oxycotin, with no relief.

My question is this..where do we go now? I am heart broken that my mother is so debilitated at such an early age. She has had chronic every day pain for so long now, that her tolerance to pain is worn down. I realize you are limited in your recommendations, because she is not your patient, but do have any suggestions, maybe something new on the horizon? I am actually considering a long term care facility, as my father can not continue to give her the attention she needs.
I thank you in advance for your consideraton.


 
Answer  I am sorry that your mother is doing so poorly. Your letter is a reminder that despite all the advances and new medications over the past few years, that none of these therapies are cures and there is still a need for better treatments. I do not know of a "magic bullet" on the horizon. All of the TNF inhibitors are approved for psoriatic arthritis as will the new ones coming on the market. I would search for clinical trials that your mother might participate in. A website called CenterWatch lists trials done in private centers as well as universities.

Last update: 03:33 PM Tuesday, April 24, 2007

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Alan Matsumoto, M.D.

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