I'm now 9 months into polymyalgic-onset, late-onset RA. Our first working dx was PMR, and since I can't take prednisone, I began researching alternatives. I found a journal article about low dose naltrexone, "The use of low-dose naltrexone (LDN) as a novel anti-inflammatory treatment for chronic pain." It documents success with LDN for Crohn's, MS, etc, and notes that patients with higher inflammatory markers saw more success. The authors suggest trials of LDN for PMR and RA.
I was unsuccessful getting LDN from a rheumatologist. However, he did give me more blood tests. They showed anti-CCP (ACPA) had developed. I had suspected it might have, but was just praying that the fact I have no arthritis in my peripheral joints (just shoulders/neck/hips, and some in knees/elbows) would prove me wrong. Rats. I have nodules in my lungs already. Weird and aggressive. I decided that my anti-inflammatory diet, supplements (turmeric/pepper etc), and low-dose aspirin weren't enough.
I am in the US. I located a naturopath who has prescribed me LDN. I'm starting with 0.5 mg, titrating up.
A week previous to starting the LDN, I began undenatured collagen (UC-II) at 10 mg. (I tried 40 mg, but I think it was too much.) I found a clinical trial (double-blind, double-dummy) comparing it to MTX in RA. In that trial, it helped. Not as much as MTX, but I'm not relying on UC-II alone. I'm hoping the UC-II will work in concert with the LDN; my naturopath is on board.
I have successfully treated my MS & fibro for 30+ years without Rx drugs. It started extremely rough but responded to a strict version of the Swank diet. Took a couple years to really help me. I don't know that I have that kind of time with the RA, but I'll be damned if I piss off the MS/fibro with TNF-alpha inhibitors or MTX, or make my lung problems worse with MTX or an immunosuppressant.
Anecdotal information indicates LDN does help some folks with RA, not as fast as Crohn's or MS, but I hope I get lucky. If this doesn't work, I'll look at other DMARDs, but they are unlikely to help me for various reasons, too. Weighing everything, this seems like my best first shot.
I'll let you know what happens. I'm a wildlife biologist with a serious scientific bent, and I view this as an experiment on myself.