Saw rheum nurse today as I hadn't improved on increased dose to 20mg of methotrexate 5 weeks ago, and in fact have been worse. My right ankle is swollen, both are agony to walk on and wrists palms of hands and elbows very painful and stiff. She could see how swollen my hands and ankle were and decided we are been tinkering too long.
I am changing to Methotrexate injections and to add leflunomide. So I will be on triple therapy, mtx Hydroxychloroquine and leflunomide. I will be reviewed regularly and if no improvement then for biologics. I don't care what works as long as something does.
My ESR was 22 which is high for me as its always been 10,11,12 even at beginning when I was really unwell. It was 17 last twice. I also got a steroid depot to tide me over.
I was so relieved she listened to me and understood how much I was struggling to work and do basic tasks. She was really lovely and reassuring. I don't want to see any more doctors, i haven't always been too sure I was getting enough care from anyone at MRI, but when I look back its always been the nurses who have been my advocates and got my doses increased, got my Hydroxychloroquine started, and now real action today. Really hope it helps!
The nurse told me today that recently it was agreed at EULAR conference that if people have not responded to 20mg mtx then no point going up to 25 as there is no difference in outcome. So don't let them waste precious months on increasing doses. After 20 oral you need injections and then change/biologics.