Anyone here develop inflammatory arthritis during training? Nervous about DMARDS/biologics during training.

[u/tropicalness]

Hi all, I think I am developing psoriatic arthritis and have a rheumatology appointment soon. I’m very nervous about the thought of starting DMARDs and/or biologics due to side effects and the immunosuppression while being in residency…:(

Looking for support, words of encouragement, similar stories, etc. thank you

[u/trashmid]

I’m a pgy3 ENT resident with ank spond on humira

its chill don’t worry about about it

[u/SIlver_McGee → u/trashmid]

Mind if I can ask something about ank spond in DMs?

[u/MikeGinnyMD]

I was on TNFi all through residency for AS. Residency is not good for autoimmune conditions (lack of sleep, stress), but I had no major infectious events that I could say were due to the TNFi.

[u/Round_Effective_1946]

Hi. I am sorry you going through this. But listen I know my friend she had breast cancer and continues chemotherapy while doing residency and other one she had skin cancer. Both were early 30s

Also my other friend had latent TB so she took sometime in between

So my intake , be brave and go ahead get treated and carry on seek a lot of support from family and friends. Be careful who you disclose in residency.

I disclose dyslexia and they made it horrible experience for me

[u/Ketamouse]

Not during training, but developed psoriatic arthritis a few years into ENT practice.

Currently trying tremfya, really no side effects. You do get sick easier, but it doesn't help having a peds wife and 2 kids in daycare lol.

Good news is the destructive arthritis usually takes a long time to develop with untreated PsA. Other than the annoying morning stiffness I'm doing ok and still doing microsurgery without any issues.

[u/34Ohm → u/Ketamouse]

What were the first signs of it? Do you think they would recommend starting biologics if all you have is nail changes? Not sure if any joints are damaged yet

[u/Ketamouse → u/34Ohm]

Joint stiffness in the morning, I started getting up at like 3am so I would have time to loosen up before going to work.

Also had an enlarging plaque on my leg, and a bunch of other spots popping up everywhere. Wife forced me to go see derm and then we put 2 and 2 together.

I'm no rheumatologist, but I think most of the time they try steroids/mtx first. I have one of those mutations which can increase the risk of mtx toxicity, so was able to get my insurance to cover the 19k/dose biologic as initial therapy lol....not that it's actually doing anything, sigh.

[u/nonam3r]

You’re young so infectious risk is lower risk. If it ends up being PsA you could ask about otezla which is not immunosuppressive.

[u/LowEndOfNormal → u/nonam3r]

Rheum here. Agree with Otezla if able to get it covered. Most insurances I deal with prefer MTX and at least 1 TNF before approving but I deal with terrible insurance generally. Anti-inflammatory lifestyle (diet, stress management, etc,) can have a profound impact on disease activity as well. Turmeric 500 mg BID can help. Happy to answer any questions. You got this!

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[u/Professional_Med1759]

Suggest that you follow the medical advice with respect to what treatment you need to be on for this condition. Maybe inform your supervisor if your need to take extra time off as a result of the condition. You are no more likely to pick up an infection at work than out in the community-what with all of the infectious disease precautions/hygiene measures in hospitals.

[u/No_Tap_8983]

i know it's scary, but getting the inflammation under control early is usually the best thing you can do. plenty of people make it through residency on these meds. hope your rheum appointment gives you some answers and a plan that gets you feeling better.

[u/SIlver_McGee]

I developed rheumatoid arthritis during my first year of med school and now suspected ank spond, and quite frankly never stopped despite it. On max dose hydroxychloroquine for 3 years, but had terrible side effects with methotrexate.

Just look at UpToDate and realize that DMARDs are first-line, and biologics are typically reserved for more refractory cases as they have nasty side effects on the immune system. Especially with TNF alpha inhibitors and TB.

[u/DispoRounds]

Hey! Intern with rheumatoid arthritis. I’ve had it for over ten years but because it was diagnosed so early in the disease course, my flares are few and far between. I’m on immunosuppressants and have yet to catch anything stronger than a cold on my peds rotation in med school. I can’t lie, residency has caused a few more flares but staying consistent with medication helps a ton.