advice the doctor Whether its a health niggle, emotional problem or youre just looking for guidance, Inspire magazines Dr Sarah Jarvis gets straight to the point Q i have verrucas on my toes and warts at the base of three finger nails. they dont respond to any of the over-the-counter products. along with everything else, it is very tedious and they are unsightly. no chiropodist can help, as they say it is a side-effect of my immunesuppressing medication, and gps and rheumatologists just tell me to treat them myself. i have been on methotrexate for 15 years and have been taking 25mg both tablets and injection for many years. i also take four hydroxychloroquine a day and two sulphasalazine. name and address withheld Q i have osteoarthritis in my lower back and in my hips, which causes problems walking. i also have problems with sleep because of the pain. ive been on different types of painkillers and sleeping tablets, but what would help me sleep? i get depressed because i am not sleeping, and my back is very inflamed. i go swimming and ive had injections, but none of them have worked. via email Do you a probl have like an em youd s so, wri wered? If Inspire te to us at: magaz 275 Ne wmark ine, Cambr e idge CB t Road, 5 8JE, or ema arthrit il inspire@ iscare. org.uk dr sarah Jarvis answers: Most people get warts at some point in their lives. Theyre caused by a virus and dont cause any harm, although they can definitely be unsightly. Verrucas are basically warts affecting your feet. They look different to warts on the hand because they get pressed into the flesh of your foot when you walk. Because the flesh is sensitive, this can make walking painful. Methotrexate works by suppressing your immune system, and I have seen several patients over the years who have developed warts or verrucas while taking it. For most people, not treating warts or verrucas is an option sooner or later a healthy immune system will fight off the virus and they will disappear without complications. Butif youre on medicine that suppresses your immune system, its harder for your body to get rid of the virus. See your GP about freezing treatment (cryotherapy) , which uses liquid nitrogen to freeze the warts off. Some practices offer this service on site, or you may be referred to a minor surgery clinic. It can take several sessions to get rid of them, but its usually successful. Otherwise, a podiatrist may be able to help with yourverrucas. dr sarah Jarvis answers: Sleep disruption can make it very hard to cope with pain. You dont mention which kind of painkillers and sleeping tablets youve been taking, but you do need to be very wary of all sleeping tablets. There are two main kinds of sleeping tablets, the benzodiazepine kind (usually temazepam) that belong to the valium family of drugs, and the Z drugs. Benzodiazepines are extremely addictive and its all too easy to end up with worse problems than the one you took them for in the first place. The Z drugs were developed to be less addictive than benzodiazepines, but theyre only supposed to be used in the short term, and its certainly possible to get psychologically addicted to them. If you are suffering from significant depression, there are some antidepressant tablets that make you more drowsy. Mirtazapine is an example, and I give it to patients with depression who find it hard to sleep. However, it can make you prone to weight gain, too. If you have nerve root pain, caused by the nerves of the spinal cord being pressed because of your osteoarthritis, there are several other drugs that might help with pain as well as sleep. One is a tablet called amitriptyline, originally developed for depression but now widely used for nerve pain. Two others are related tablets called gabapentin and pregabalin, both first licensed for epilepsy, but also used for nerve pain. Even though you say swimming hasnt helped, it is important to keep as physically active as you can. arthritis Cares helpline is staffed by qualified counsellors who can give you emotional support, and its free and confidential. Call 0808 800 4050 the line is open Monday to Friday, 10am to 4pm. arthritis Care also has a number of free booklets about arthritis that you can download. Click here for more information.