NRAS
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Any idea what’s next?

So, I’ve been on hydroxychloroquine for approx 13 years, with methotrexate added in 6 months ago as flares started up after a really dormant time. Whilst I’ve not suffered side effects I also don’t think the methotrexate has helped me at all..... I’ve had steroid jabs to deal with flares during this time, when things were unmanageable. .... I see consultant again in March.... is it fair to conclude that the methotrexate isn’t working... and if so, any ideas as to what the next step might be. I’ve made Big lifestyle changes in an attempt to manage the fatigue and pain, but only the depomedrome jobs have helped as far as I can tell. I know everyone is different, but wondering if anyone else has similar journey? I’m 48, and recently in surgical menopause if that’s relevant, also taking hrt on advice from gynae

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Speak to your rheumy and ask them,you can ring the hospital and speak to the rheumy nurse about how your feeling.xxxxxx

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I believe you may be eligible fir a biologic. Speak to your Rheumatology specialist nurse as Sylvie says xx

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Hospitals differ, but sometimes the requirements to qualify for biologics are quite stiff. So if you've only tried hydroxy and MTX so far it is possible that they'll suggest you try Leflunomide instead of MTX - unless you have problems with blood pressure.

Here's the link to the NICE pathway, but it's not hugely detailed so leaves quite a bit of space for doctors to choose alternatives.

pathways.nice.org.uk/pathwa...

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I agree. I had to go through 3 ‘failures’ and blood tests before I was even considered for biologics.

I would definitely ask what your options are.

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Know how you feel. I too was on Mtx for 10 years which caused my liver functions to increase now am off it Hydroxychloroquine for 14 years which stopped working with the flare-ups was also taken off. We discussed biologics and decided on Embrel was a great blessing. Flare-ups were down to maybe two a year with weather changes. Adding Mobic to help with pain has made life easier for me. Talk to your Rheumy for advice.

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