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Which Drug ?

At my last appointment with the Rheumatologist, she gave me three leaflets on 3 drugs.

Leflunomide,Methotrexate., and Sulfasalazine. I have no idea which one would be the best one for me to try. I have just read all the posts, and replies on here regarding Methotrexate, and am still unsure. Has anyone had any of the other two drugs?

I would appreciate any advice please.

12 Replies

I believe they are all DMARDS disease modifying drugs so the action is the same. I and most people start on methotrexate as my consultant said that was " gold star"

However they will be same action and if one doesn't suit you they will probably change you to another one.

Nras on the website have a drug description section which may help xx


I started on Sulfazalasine, no change then mtx was added with hydroxocloroquine no change, now I'm on mtx with Benepali still a lot of inflammation in hands and pain so soon time to try another biologic I think


I was started with sulfasalazine at first and the on methatroxate and I'm ok on them but there will some lovely people will come along and maybe give you some advice, or send you too your GP.




They all have pros and cons, and everybody can react differently to each of them anyway.

Methotrexate is the most likely to be effective, as tends to be ok for the majority of people and be the most useful at controlling RA. But people often find it the most scary.

Leflunomide is similar in its ability to control the disease to Methotrexate but slightly less used, not sure why but might be as it's doesn't work for quite as many people as MTX.

Sulphasalazine is seen to be less "strong" in its ability to control the disease, bit equally has less scary side effects. Unless you happen to be someone who it disagrees with, in which case it can be very, very horrid.

So it's a choice. But remember that starting something doesn't mean you have to stay on it as you can stop anytime. And you will be well monitored whichever one you choose.


I have been on methotrexate, actemra and humira. And...during my time on Humira showed stage 1a breast cancer. Odd. And they take you right off of any biologic - because it might CAUSE breast cancer. Duh. During my radiation, the doctor prescribed leflunomide. So far, so good.

So...methotrexate and leflunomide head to head? Well Metho is a drug used in cancer treatment as well as rh. a. It will do the job most likely. After about a year on it, I started to retch about two days after taking it. Out of the blue. Just felt as if I had put my finger down my throat.

Now...remember, Metho was one of the first I took. And then it was combined with the Humira for a while. I didn't see much relief at any turn. And the costs of Humira (a $500 co-pay AFTER cost exceeds $4k a month, a MONTH.)

Leflunomide is doing it for me. I have some pretty bad indigestion, but frankly, it's easy after the other options. And it doesn't list "possible cancers or melanoma" at the "reactions" site. That did it for me. Total cost - $27 a month.

Now, it's not just big pharma. Most people react to Humira and other biologics just fine. It just didn't do it for me.

That said - it may or may not do it for you...meaning try one of them. (I have not been on Sulfa.) Give it six months, unless you have serious side effects.

Every BODY is different. Good luck. I write notes to myself on a calendar to remember what I felt on a particular day. That helps as I was feeling overwhelmed. I am in my fifth year of diagnosis.


Just to clarify methotrexate is used in Much higher doses for cancer patients.

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Sulphasalazine with hydroxychloraquine worked well for me for my first 3 years but as many find I have now reached stage where a change may be called for.


I maybe old fashioned, but is it DIY week for choosing a drug?

I rather like the idea that a Consultant Rheumatologist would explain which drug in her professional clinical opinion would be most suitable for you.

Are you going to see her again to ask questions & discuss the choice?

Before I have taken all drugs, including Dmards & Biologics either my Rheumy or the Rheumy nurses have explained everything to me& then advised which they think willl suit me best. As I knew nothing about each drug, (still din't really) I could question them & then take their advice!

I do wish there were more rheumatologists practising in the NHS.

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Hi I see a different one every time I go, its ridiculous. That's what she gave me, to read.

So I'm loosing faith in the NHS.


Thank you for replying, it's great to be on here and take it all on board, and digest all your advice. I will see when I get another appointment, on what they say next xx

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I've been on MTX and now on LEF.

MTX did nothing for me so after 4 months they moved me to LEF, which, apart from weight loss, I've been fine with. I watch my BP and have been warding off infections so no bad reactions. No reduction of pain either, sadly.

When I started with MTX tablets, my stomach did not like them at all (very churned up and 'loose') and so onto the sub-cut injections which are a piece of cake. If you have reactions to needles it might not be the route to take but they really are painless.

I really do think one needs to go with the recommended course of action from your Rheumy. While there are legion posts here of the difficulties of any drugs, you have to opt for one and try it out.

The choice of non-of-the-above is an assured route to continue with the pain. It's your choice, but for me it's a case of believing there is something out there which will work - I just have to take what they suggest until I find one.

They are scary drugs, for sure! But one of them will likely work and that's the risk/benefit calculation I work with.

Good luck with it.

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Thank you, whats LEF ?


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