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Choice from my Rheumatologist..After taking sulfasalazine for 3 months with no decreased inflammation.

1. Increase SSZ to 6 a day and try for longer.

2. Switch to Methotrexate or Leflunomide

3. Switch to Enbrel

I've had RA since the 1990's and have always tried to take the least toxic meds.. So I've used hydroxy, minocycline..Plus nsaids and steroids.

I worry about the side effects particularly as I'm now older and our NHS is deteriorating in elderly care.

I think I'll try increasing the ssz for a while, as it seems the least toxic choice but if that doesn't work I absolutely don't know.

Any suggestions or advice please?

12 Replies

The biologics are claimed to be cleaner drugs offering less damage to organs and getting the RA under control quicker. But you'd still need the prescribed drugs. Good luck x

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Go for Enbrel...likely to be more effective and hopefully less toxic.


Well I view NSAIDs and steroids as tough choices too - they can cause just as many serious problems as the disease modifiers. To me it's all about trying to find the least worse balance that does keep the disease in check.

So yes a bit longer on Sulpha seems sensible as it can take a long time to work. I went up to 3g of it for a while, with no ill effects. But if your inflammation levels are high don't keep going for ever.

The other thing to consider is that you are usually recommended to take MTX or Led (at a small dose) alongside the biologics as that seems to give the best results. So if you might have to take one of them anyway then you could dip a toe in the water by trying one of them by itself first?

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Hello , I'm intrigued as to what led is . Also intrigued that there is another option of drugs . I have tried Methotrexate, sulphasalazine, currently taking Hydroxychloroquinne & Leflunomide. Been taking them 5 years but the diesease isn't in remission.

I was told there is no other option unless I take steroids . So the next step is biologics.


The drugs I'm on now suit me as I don't have side effects.


Predictive text! Lef not Led...i.e. Leflunomide


OK. I thought there was another option .


Well I would up dose of Sulfasalazine. I asked my rheumy to do this for me and he said I was already on highest dose which was a lie.I have tried 3 biologics including Enbrel without success and also methotrexate which started damaging my liver. I take hydroxychlorine and that improved me a bit but think it's my Prednisolone and Pregabalin that keep me going

Its so confusing to be asked to choose when they are the experts thou

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i thank my lucky stars I fitted the criteria for Enbrel!

My liver can't tolerate Mthx or Leflunomide ( very high ALT ) and Sulfasalazine nearly finished me off I was so allergic to it.

My Rheumatologist said to me ' don't worry we are going to get you on the good stuff'

I know you have other considerations and it is a minefield of decision making and worry but If I was in your situation with the benefit of experience I would be taking the Biologic.

Good luck to you


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I have been on methotrexate, Leflunomide now sulfasalazine for a year. Was told a month ago to up sulfasalazine to 6 a day still no relief in fact it's getting worse. I am at my wits end in so much pain and not seeing Rhummy till July. What. Do we do have seen doctor and tried pain killers . Don't know who to turn to next is any anyone can advise me out there.. They wouldn't leave an animal out there like it. All we ask for is something to help release this terrible pain and disability


Hi guys,

please remember, no direct recommendations. Restrict your comments to your own personal experiences please.

Californiadreamer if you would like to call the helpline to have a chat about this please feel free to do so:

0800 298 7650 Monday - Friday 9.30am - 4.30pm


Beverley (NRAS Helpline)


Thank you everyone....It's such a major decision, I worry about making the wrong choice. I have had a long discussion with my Rheumatology nurse.

I've decided to continue with the Ssz at a higher dosage for a couple of months maximum. If that doesn't work then I'll switch to Enbrel.

Hoping that the SSZ does work as it's the easiest one to fit in with international travel. We visit our family in New Zealand for 3 to 4 months and the logistics for that would be difficult...But..Not impossible hopefully.

Thanks again to those who took the time to reply.


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