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Triple therapy drug swap?

Hi all.

OH has now been on the combination of sub cut MTX, hydroxy and sulpha for 7 weeks (MTX for about 9 months, hydroxy for 4 months) and since starting the sulphasalazine seems to have become more poorly.

It may have reduced the evening fatigue a little and possibly reduced the chills he was getting, but if anything his joint stiffness and discomfort (hands, shoulders, hips and knees) is worse, his irritable bowel type symptoms are much worse, he's been itchy all over and generally just feeling ill most of the time.

I've just read a few old posts on triple therapy, and I see some have been unable to tolerate the sulpha and others have just taken a long time to get used to it.

He should have an appointment with his consultant in the next couple of weeks. When we last saw him he said if the DMARDS really aren't working, he would look at biologics, but it might not be easy to get them as not sure if OH will score properly (the consultant did say that he will make sure OH can get them if he really thinks it's worth a try, so that was reassuring). So, is there another option before that? Has anyone had sulfasalazine taken out and lefluonomide put in and has that helped?


5 Replies

Of course only your rheumy can answer thoroughly, but it seems to me that most people take either Lef or MTX but not both. However it sounds as if you've given the current drugs a good go, so worth discussing with your rheumy. As you know some people do miles better on one drug rather than another.

As for qualifying for biologics, have you tried one of the DAS apps to see how you score? You'll need to know his ESR/CRP and estimate the number of swollen & tender joints but it could give you an idea of whether you're close to the magic 5.1? If not then the medieval approach in U.K. is to come off all drugs to make you flare so your blood tests rise and your score more highly. Which is evil to my mind!

1 like

I was on Methotrexate and Sulfasalazine but dumped the sulfa in favour of leflunomide - lasted 7 weeks on both but boy oh boy was I poorly. Really sick fatigued and took a bad toxic rash all around my neck....three weeks on its still really visible!


Yuk! Poor you. Seems there are exceptions for just about everything with RA. The sooner they can get on and find a way to work out which drug will suit each person the better.

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I'd go along with your rheumy's advice if I were you. .....he is keeping you informed of the way he thinks he will treat your OH & I think that is a good sign that he cares.

I had a bad time in Ssz, & eventually went on to a Biologic & 18 months along - after 18 yrs of RA I am feeling better than I have for years.

But of course Biologics don't suit everybody......so take things calmly & try to get your OH to look at Biologics as just another drug......by all means read up on them......but don't scare yourselves silly !

Good Luck to your OH


Thank-you all.

Aged crone would you mind saying how Ssz was bad for you?

Marie66 that sounds horrid - are you getting on better with lefluonomide?


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