If you were just diagnosed, were early in the disease, and were not having terrible pain (a lot of stiffness & reduced energy though), what would be your medication of choice....
Methotrexate--Seems like there are a lot of precautions, NO alcohol allowed (oh my!), seems like a strong med.
Sulphasalazine-less intense, not as many side effects.
Enbrel-given as injection, increases energy, not as many side effects.
Any particular med you would say "start on that one" or "hold off on that one if you can". Someone told me not to let the research on Methotrexate scare me....well, it did! Anyway, I find myself leaning toward Enbrel, I don't mind the shot, and I REALLY could use my energy back, but is that for more advanced cases of RA? UGH...sorry to have so may questions, if you can't tell, I truly value your opinions...and don't worry, I know they are just that...OPINIONS
I have been on methotrexate now for nearly five months. I haven't found that it has personally worked for me, however, I wouldn't get all carried away about the side effects. I know that in researching it it looks really scary, but it really isn't that bad. I wear a medic alert bracelet saying that I am on it in case I ever had to go to hospital, and I pretty much avoid alcohol (I know...that sucks...I'm 22 and a student so I totally get it)...however, I've just accepted that for right now I need to make a lifestyle change in favour of my health, and as hard as it was to accept, I actually feel a lot healthier all around now. The only side effect that I have ever felt from methotrexate was being tired. Also, just so that you know, methotrexate can come in the form of an injection too. That's how I take it.
Britenny
I also know that most US ins. companies will not approve Enbrel until you've not responded to the older DMARDs. Personally, I have no expereince with Sulphasalazine. I've been on both oral and injectable methotrexate with no problems other than some nausea and fatiguew which were worse on oral than inj. As you've been told, don't let the things you've read on MTX scare you. Responsible docs keep close tabs on labs while you're on it and most are quick to make changes if problems arise...and most MTX caused problems are reversible when use is discontinued. take the normal precautions of following your doc's advice on it...some say no alcohol, others say an occasional drink is fine if you've had good labs. mine gave me no comments one way or the other...figuring i knew about it since she knew i do research on everything. (she frequently didn't tell me a lot of vital things)Hi Staci,
I can't really answer your question, but I just wanted you to know that I've been taking MTX for over 10 years now without any problems. It's really worked well for me. The only problem I've had, has just started in the last few months(low white blood cell count), but that is being watched with my monthy bloodwork.
I was exactly like you when I read about MTX. Took me along time to finally give in and take it.
As far as alcohol goes, I have the occasional glass of wine. I don't drink all the time, never have..but when we have company over, I have a couple of glasses of wine.
Good Luck,
Kelly
I AGREE STACI. MTX IS CURRENTLY THE MOST WIDELY USED START UP DRUG FOR RA AND GENERALLY USED IN COMBINATION WITH ANOTHER DMARD AND NSAID DRUG. INS WLL NOT LET YOU TRY THE BIOLOGIC UNTIL OTHER MEDS HAVE BEEN EXHAUSED. BIOLOGIC COST RUNS ABOUT ,000 YR PLUS SO THAT'S WHY. I AM CURRENTLY ON SULFASALAZINE AND MOBIC AND FEEL IT'S NOT CUTTING MY RA. MY PAIN AND INFLAMMATION IS BETTER BUT ONLY ABOUT 50%. DIFFERENT DRUG MIXES ARE DIFFERENT FOR EVERYBODY. DON'T BE AFRAID OF MTX AS IT HAS HELPED MANY PEOPLE JUST USE PRECAUTION; STAY AWAY FROM ILL PEOPLE AND LIMIT ALCOHOL. NOTIFY YOUR DR IF YO GET ANY ILLNESS. IT IS A POWERFUL IMMUNE SUPPRESANT BUT IT WORKS. GOOD LUCK AND LET US KNOW WHAT YOUR RHEUMY PUTS YOU ON. WE'RE HERE FOR YOU!!Staci, I see your point. If you aren't in great pain I think maybe you're right. Start out on one of the weaker DMARDS like Sulfersalazine or Plaquenil maybe. Save the big guns for later when you need them. It may never come to that.
I've had RA for more than 11 years now. I started out on Sulfersalazine and eventually added Plaquenil once Sulfersalazine wasn't enough alone. I didn't start MTX for close to 8 years into it. Now I'm up to 22.5mg MTX & Humira weekly.
It's been my experience that as time goes on you need more and more to keep it at bay. If you can keep it at bay now with less invasive treatments that would certainly be my choice.
MTX has been a wonderful medication for me; and I started using it at point in my disease when nothing else was working anymore. Had I not been in pain like I was and exhasted other avenues I would not have wanted to subject myself to even a chance of what the medication could cause. Why chance it if it's not nessesary.
I'd definately try some other things first. ESPECIALLY if you aren't suffering too much right now. Don't forget that you've got years to live with this disease. If they don't work you'll always have MTX & the other biologics waiting in the wings.
What exactly is sulphasalazine? I recall the doctor saying that if methotrexate doesn't work (i'm on 20 mg injection a week and 400 mg of plaquenil six days a week) that I may have to add in sulphasalazine before trying biologics. But from what I have heard, it seems as though sulphasalazine is kind of a mild drug? Anyone who's on it...can you comment?
Brit
It is a mild DMARD; often used as one of the first lines of defense for RA.
It was the first one I was prescribed years ago.
Hi Staci, I've had RA for 13 years and up til last month I was only on MTX, prednisone and naproxen. I had tried plaquenil and it didn't help me at all. MTX hasn't given me any side effects, only a little bit of fatigue, but that wasn't til I started taking 7 pills a week.Britenny,
I've just added Sulfasalazine a few months back. I had been taking 25mg MTX and 400mg plaquenil. The sulfasalazine has helped a bit. I think it is fairly mild like you said. On it's own, not sure it would do much, but combined with some other DMARD's it can help.
Kelly
This information has really helped! I was thinking that I shouldn't take Sulfasalazine because my Mother was allergic to Sulfa and I thought I may be too, so why chance it....BUT, I think it may be worth a try to stick with the more mild meds for now. Whew...I'm exhausted just thinking about it My first doc only prescribed Plaquenil. He said read about it and decide if you want to take it. I didn't and didn't take him either. My current RD gave me 3 choices Plaquenil, Sulfasalazine and MTX. She felt that the MTX would work best at suppressing the RA. Besides, I didn't like the fact that I had to do frequent visits to my Opthamologist if I was on the Plaquenil. So far so good on the MTX.Staci the key to living well with RA is to prevent permanent joint damage. Joint damage happens early for many - before they even start to realize (ok admit) they have an illness.
MTX is the gold standard treatment for RA it does the job for most of us. It is well understood - your ra doc knows exactly what watch for.
Take MTX, do your labs, no more than 2 drinks a week if labs are good.
You have a real chance to put RA into "remission" and shot RA down before it shoots you.
I SURE WISH I HAD TREATED MY RA AGGRESSIVELY - MAYBE I WOULD NOT BE CRIPPLED TODAY.
Staci.. start small and get bigger... add to the mix.. try a drug and if it diesnt work, call in for something new... usually you know if its not going to work for you in a week or so... I am not scared of MTX.. never was..
Well here's my 2 cents worth... my doctor beleives that aggressive treatment is the best- he put me on mtx and prednisone then Enbrel-He says that you need to stop the RA in its tracks as quickly and as much as possible to alleviate joint damage. He has done alot of research on this disease and says that he thinks that MRI's are foing to be the best diagnostic tool out there- he says you can see damage on an MRI earlier than X-rays. But he says the insurance companies do not like his treatment methods. But he doesn't like their lack of knowledge with this disease- so he is relentless with the insurance companies. So I know I am very lucky to have found him and to have him as my doctor.
Turned out I was allergic to mtx and so I was put on sulphasalazine. It is the drug they use when you can't have mtx- it also slows down the joint progression and when I had my labs done- it brought down the inflamation in my sed rate and crp???? anywhooo I don't think it does anything but my blood does. The test was prior to the Enbrel - those are the meds I take-