It looks like my next visit will result in an increase in my medication since the neurologist agrees the AI disorder is not under control. So I have a couple of questions for those of you who have already been this route. I'd really like to have some information ahead of time so I can ask intelligent questions when I see the RD. I'll also do a search on the individual qualities of the different medications, Enbrel, Humira, etc. based on your responses.
First, if I am increased from 20 mg. MTX to 25, do I have to go the injectible route? One person here posted that once the dose goes up to 25 mg. the body doesn't absorb it well and it has to be injected. Can you comment on that? Do any of you take 25 mg. orally?
I'm already at 200 mg. of Plaquenil twice a day and I believe that's the limit. Does anyone take more than that?
What is the usual med prescribed next? I'm allergic to sulfa drugs so that's not an option. Enbrel? Orencia? Or am I skipping step here? Any information you can give me will be very much appreciated.
I am sorry I can't answer your questions on the meds. Just wanted to tell you good luck and I hope they find something that works on you. And not have to keep switching and trial and error thing.Hi Jesse, am sorry that you're going to have to go to the next level of drugs. I'm not sure about the statement that you have to inject 25mg of MXT. I use injectible MXT because it absorbs better than when taken orally. I figure every little bit counts. I also have less side effects. Enbrel or Humira is usually the next drugs that the RD will prescribe. Keep us posted and when is your RD appt? Lindy
Jesse - that's what my ex-rheumy told me, that after 25 its MTX injections, then the "big guns" as he put it, which I took as biologics. Which also meant he was telling me to expect the MTX pill to fail, the injections to fail, and the big guns to fail.
I was started on 200 Plaquenil and never was adjusted up or down, but that was for leg cramping, not the lupus I might or might not have since no one ever pinned it down. Good luck.
Jesse88,
I've read that the max dose you can take of Plaquenil is 600 mg but I've never seen anyone on that high of a dosage. I started on 200 mg twice a day and my RD never adjusted that up or down.
I really don't know anything about Undifferentiated Connective Tissue Disease. Is it always treated the same way as RA? If so, becuase you are allergic to sulfa drugs, I'm guessing your RD would try either Arava, or add a biologic. Just a guess.
I went from MTX to Humira...which I believe is becoming more and more common...transitioning fairly early to a biologic. I wouldn't be surprised if that trend continues and eventually people with RA are started off on a combo treatment of MTX and a biologic...studies show it's the most effective treatment.
Alan
PS: I take Arava and Humira now since I had some problems with MTX causing a rather severe case of thrush (candida).
Thank you all for the good information and encouragement. Now I have a starting point to research. It seemed like a waste of time to study drugs I may not even be near to needing yet, so this is a great help to me. Lindy, my next appointment is Feb. 5 which gives me plenty of time to do my homework, but I think I'll ask for an earlier appointment if there's a cancellation.
Kweenb, undifferentiated connective tissue disease (UCTD) is treated the same way as RA because it's related. My blood work says conflicting things, one says positive for RA, another says, not so much. Positive for lupus, but maybe not. High ANA and ANCA, boderline high SED rate, etc. In short, there's a connective tissue disease but it's not clearly any one kind. It could morph into one of the specifics like RA or lupus, or may not, depending on how well my treatment works. The autoimmune inner ear disease thing I'm fighting now came out of left field but it's all related to the vasculitis and/or UCTD apparently.
So now I'll learn all I can about these drugs so I'll be well informed come appointment time. Thanks again. You've been a great help and any other info you'd care to share will be most welcome.