What treatment comes after MTX...? | Arthritis Information
I'm on plaquenil and mtx right now but I have the feeling that my RD is going to want to take "the next step" when I go in next week. I've lost some mobility in my elbows as it is (they don't straighten, there's like a 2 inch gap
He gave me a sheet on TNF Inhibitors--anyone on them want to share? And aren't there other options? I thought I heard of upping the mtx dose before doing anything. I know what comes next isn't the same for everyone, but I'd like to know my options. Thanks guys <3
hi..gypsy mtx can be raised to 25mg.. reading a lot of posts it seems biologics
or anti tnf as we call them in uk are being used very early on in the disease now.
i have not used them.. but other meds i have had are
gold injections
arava
azorthiaprin
sulphalasine
Boney ... ps boney is me and not a med
[QUOTE=littleistgypsy]I'm on plaquenil and mtx right now but I have the feeling that my RD is going to want to take "the next step" when I go in next week. [/QUOTE]
What comes next is different for everyone, but there are three general ways I would guess your rheumy is going to want to go here. One, up the dosages, like you said. Two is, again like you said, to augment the mtx with a biologic. I think most people tend to start with Enbrel. Three is to change the mtx to another traditional DMARD, like Arava or Imuran. Or he might do more than one of those things.
[QUOTE=littleistgypsy]He gave me a sheet on TNF Inhibitors--anyone on them want to share? And aren't there other options?[/QUOTE]
Yes, there are other options, there are many different options: traditional DMARDS (mtx, plaq, etc), various categories of biological DMARDS (TNF inhibitors, B cell depleters, T cell blockers, IL-1 therapy, and soon IL-6 therapy), AP (antibiotic protocol) and prednisone (although this doesn't stop the disease process). They all have their pros and cons, but it seems that TNF inhibitors are often the first or second option for many rheumys.
I tried Enbrel as my first med. It wasn't successful for me, but it is for many people, which is why it is such a popular starting place.
[QUOTE=littleistgypsy]Also I'm experiencing shooting pains in my small joints[/QUOTE]
You might want to ask your doctor if this is nerve pain (shooting pain is typical). If it is, they can add an anti-neuropathic med like Lyrcia or Neurontin which may help.
littleistgypsy,
I started on Plaquenil. Then added MTX. Then added Enbrel.
Hey I get the shooters too. THey come and go fast so I dont' medicate them.
I started on MTX (10 mg) in November 07.. then upped to 20 mg in February. At today's appointment, RD said he was seeing a stall in progress and wants to start Enbrel.. I am waiting til Monday when the results of a TB test are back and we can proceed.
From what I've learned from all the wiser ones here, each of us is different. But there seem to be patterns in what the RD tries..
Good luck to you!!
once I reached 25mg I started Humira. Six months later I had to add humira weekly verses bi-weekly. I did that for two years and then stopped the Humira for reasons I don't have time to explain now. It did work really well though.
THat's been about a year and I had managed pretty well with only MTX. Not's not really the case anymore and I'm hoping my doctor will agree to let me go back on Humira on my appointment on Monday. We'll see.
I would try to max out your MTX (Usually 25mg) before moving to anything else. You may already be there; you didn't say.
For those of you who have had drugs added to your treatment-
Was it because you still have significant pain and swelling? High blood test numbers? Or both?
Hi
There are different paths, but it does seem like if it's DMARD/biologic combination, you generally up the mtx first to the max before adding a biologic. Are you at 25mg and how long have you been on it? I started mtx at 12.5, increasing to 25mg over 4 months, still some activity (swelling mainly - limited pain) so Enbrel was added. That combo seems to have taken care of the remaining activity - even the fatigue was a little better (except for the day or two after mtx)
As far as which biologic if that's what's decided, everyone will have different experiences, so you'll just need to weigh the pros and cons of both, check with your insurance to see what the differences are in benefits and for me the most important thing was to not get too hung up on the side effects. While they are scary, all drugs have side effects and a long list as they have to list any and all that may have occured. Better to be aggressive before you have damage.
Good luck with the decision - hope you find a good combo.
Cathy
Does raising MTX depend on your size? I'm 115lb/5"1', and am at 15mg (which is what he started me on).
The reason I'd prefer not to start them is that I believe they're injections (right?) that have to be given by a nurse (I think?) and I have no way to get to my Kaiser, which is 15 minutes away... except by having my mother, who lives an hour away, drive out and take me. And that would suck. I guess I could take public transit... but that would also be not so awesome. (And okay, I am being whimpy about this, but I HATE NEEDLES kldfjajdf. Alot. It's so freaking ironic that I get a disease that requires blood draws every 3 mos! God has a sense of humor f'sho.)
Are all the biologics injections (if TNF even is) ?
Also, if you've ever tried them, what side effects did you experience?
Littleistgypsy,
You don't have to go to the doc for injections. You do it yourself at home. I like the Enbrel Sureclick because I don't have to do anything but hold the injector to my skin and click a button. That's it. They are already filled with the drug, so you don't even have to worry about that.
I have never had any reactions from Enbrel, not even redness at the injection site.
You should know that if you want to try the max of the MTX before going on to the bigger guns, you'll need to inject the 25 mg. Some doctors won't even give anything higher than 20 mg. in the pill form and regardless of the dosage, the injection is 20-25% more effective. You'll get more bang for the buck and maybe won't have to move up the meds ladder at all. I don't like the injection, the pills were so much easier, but I really do feel like I'm getting better results now from the injected MTX. Are you also on the max for Plaquenil? My understanding is that in most cases, 200 mg. twice a day is the max, but some doctors bump it up just a little. That may also be an option, rather than moving on to something else. I'll be interested to know what your RD decides. I've been wondering myself what will happen, if/when my Plaq. and MTX stop working. Wow, I had no idea mtx could to be injected... and at least you can do it at home (I assume). It's probably more expensive though, which is a bummer.... I'm pretty sure he won't up it 25 as my liver is not too happy with me as it is.
I'm at 300mg of plaquenil once a day.
I'll post again after my appt next thursday.
Thanks guys, this really makes me feel better! Ok, what does 'kldfjajdf" mean. Somebody PM me if it's something I should know, OK?
Here's the ACR info on your options - look down the page for medications.
And here's my favorite.
I think it's a really good alternative.
Hugs,
Pip
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