Review with nurse at 4 months

[Chickenkeeper2015]

On the 19th OH has an appointment with one of the is rheumatology nurses to review how things are going.

We were told we needed to give the methotrexate 12 weeks, at this appointment it will be 13 weeks on oral methotrexate, plus 3 weeks on methotrexate injections (2 at 20mg and one at 25mg) - so a total of 15 weeks.

If anything, the RA is worse than ever. Joint pain and stiffness are horrendous, as is fatigue and general ill feeling.

My question is, what can we expect from this appointment? To me, it seems that methotrexate alone is not working, and at the very least something else needs to be added in. Can the nurse prescribe a new drug? If not do we then have to wait another 6 weeks to see the consultant again? Or is the nurse just likely to say 'You've only been on the injections a few weeks you need to wait longer'?

Also, there's a really important family event coming up that involves spending the whole day on his feet. I'd it worth asking for a short course of steroids to get through it? Or will they just say no?

Thanks.

[Beaches2]

Hi

I've seen my specialist nurse since I was diagnosed and she is great. Very knowledgeable with plenty of time to talk. At my early appts when we had to keep adding things in, she would discuss with me, then pop in to see my consultant to discuss our choice. I think though they can prescribe without consultant there? They will normally have had a team meeting before the clinic to discuss their caseload. They can certainly change doses etc and write out a script for you, so no, there should be no wait to try another Dmard alongside mtx. I had leflunomide added in after about 6 weeks......we were going for the " hit it hard" and maybe it will go away approach! She may also think that giving it a little longer at 25mg will be enough to control things......I guess that's something for you to discuss.

I used to see her every 6 weeks and got a steroid jab at each appt.....sometimes into a joint. My area seem to do that rather than tablets.

Although steroids are not good for us long term, they do have a role to play early on in getting things under control so if it's not offered anyway I would definately ask.

[helixhelix]

Like Beaches2 I found the nurse very useful in the early days. She/he will probably only count the number of weeks on MTX over 10mg, so that might be less than 15? And will also look at whether the blood tests have shown improvement? There can be a reluctance to change things if blood tests are showing that it is having an effect. However, if your OH really doesn't feel it's being effective then push a bit! With me the MTX had helped noticeably, but not enough so I asked about options and was offered another drug to add in.

I also had steroid injections quite regularly in the first year - I prefer them to the oral steroids (which I won't take anymore as they make me go loopy!). The hospital I was at allowed 3 injections a year. And they basically allowed me to function while the drugs took effect. All in all it did take over a year to get stabilised.

[Gnarli]

Hi chickenkeeper2015

Your OH must be about 2 weeks in front of me, regarding treatment. I saw the rheumy nurse last Friday. I've been on mtx 25mg and at the previous appointment "adding in a little something" was discussed as the bloods indicated no dropping of the inflammation levels and still got some swelling and pain. So, its 500mg sulphasalazine a day from next week building up over four weeks to 2000mg. We all react differently and rheumies have their own ideas so can't second guess what will happen but it would be well worth asking for steroids to get him over a tricky time. I hope the appointment goes well for him. Please let us know how he gets on

Jan