I forgot to ask this earlier...My RD was talking about increasing the mtx and then progressing to the next level if that wasn't working. Is there a clear progression of what comes next in terms of meds? or is it whatever the preference of the RD and insurance is?
Thanks
LT
There cannot be a standard progression in that individuals react different to the medications used. Some medications don't work well for some people and for others they are life savers. But as a general rule, they try OTC pain meds first (depending on your bloodwork and inflammation), then MTX or Arava, then they might add something like Plaquenil and then move to the Biologics.
The insurance companies pretty much insist that MTX be tried before biologics and often the Rheumy must take this step first even if he/she feels you'd do better with the biologic. Usually, they will do a combination because they work better together. It does take a few months to usually see some results, so hang in there. But if you still have bad inflammation or pain, do let your doctor know so that they can start working on other solutions. I believe it takes MTX about 3 months to start giving relief. In the meantime, they probably will use pain killers and prednisone to keep things under control.
But it does vary per patient and the best thing you can do is communicate with your doctor as to how you react with the meds.
I started with Prednisone, then Plaquenil (had some nasty side effects and it really didn't help). I'm now on MTX and he recently increased the dose. I discussed my interest in biologics and like Deanna said, he told me he had to get throught the MTX first or the insurance may not pay for it. Plus, I'm only on my 3rd month with MTX.
I'm wishing for some Pred today though, I'm having a pretty bad one. But I know in the long run, I'm better off without it.
Thanks. You have pretty much confirmed what I thought. The RD has been pretty aggressive in starting me immediately on plaquenil,15mg mtx and folic acid. He is already talking about moving the mtx up to 25 in Jan. and then the "next level" in Feb. I wasn't sure if I could be so lucky at to get to the biologics that fast, or if there was a sidestep level drug that happened first.
I guess in some ways I feel lucky that he seems to be aggressive with this, but even so the hurry-up-and-wait-while-we-see-if-it-works, really bites!
laurat, I know exactly what you mean about the hurry-up-and-wait-while-we-see-if-it-works. Seems so goofy. Thanks for saying it that way. I'm one of the reasons why you should hurry up & wait. I started with MTX, and it pretty much did nothing. We kept upping the dose. Then we added in Arava, and Bingo! Within 3 weeks, my RA was under control. Now, nearly half a year later, I'm not quite as good as I was, but I'm not ready to move on. It CAN happen. For me (I'm new here, btw) they (I've had 4 RA docs and my GP) had me on just about all of the available NSAIDs...only Bextra gave me any relief at all, but it was very minor...my newest RA doc (number 5) just started me on Plaquinil (200 mg/day) and Prednisone (5 mg/day). I've been on them for two days...guess I have a pretty long wait for relief ahead. I just hope something works before I have to quit working (I'm almost there now).I've been lucky in the respect that all of my early medications worked well for me. At least for a while.
Years ago (Almost 13) I started on Sulfersalizine, and a prescription antinflamatory. That was good for a while, then we had to add plaquinel. That too worked good for a while. But as history has proven....things lose their effects eventually. I'd add more and more until I've worked my way out of something. After about 8 years I guess I started MTX. That alone was good for quite a while; but true to form; I eventually had to start Humira.
What I'm trying to say is that I didn't need the strongest of meds right off. I'm glad my doctors tried the lesser of the drugs first and found that they worked. It's saved me from using heavy medications before they were actually needed.
RA is a progressive illness that I'll have for the rest of my life. When I started I was 22. I've got a long life ahead of me still.....no use in using up my options too early; if I don't have to.
Does that make sence? Does this post even apply here? It's real early and I feel like I'm babbling. lol
Lovie, babbling, hee-hee. Now that's a first.
RJazz117, welcome aboard. I'm really confused at your previsous doctors' treatment of you. When you see this new one again, ask what his treatment plan is going to be with you. You have, after all, been getting the runaround from your previous doctors. Couch in those terms, that you need to know that you are going to get treatment, not just more anti-inflammatories. If you are still experiencing a great deal fo inflammation, don't wait until you next doctor's visit to let him know. Plaquenil does take about 3 months to start showing an effect. All the DMARDs do. But if you are not getting relief, or are getting worse, call the doc. Sometimes they need to move the treatment on a lot more quickly.
However, as Lovie said, it is a good thing to start on the lower end with plenty of room to go. I've run out of room and they are starting to take medicines away from me or they just plain don't work. I have a lot of years ahead and that's scary.
Patience is the hardest thing to acquire. Persistence in getting answers is also necessary.
There is a very good chance that you don't need something stronger than Plaquenil. It can be very helpful. So, give it a try. Holler if it's not working.