Does anyone have suggestions for oral medications before trying Biologics? See below for details.

[mainstreet]

It has been a while since I have posted because, thankfully, things have been stable. However, that has changed. I wanted to see if anyone has ideas about oral medications for RA. I started with methatrexate (had terrible mouth ulcers), then tried Areva and had hair loss. I tried Sulfrasalazine and got more ulcers. I went back on 20 mg Areva and that has been doing really well for about 6 years. Then a few months ago, my white blood cell count dropped below normal range (2.7). So we cut the Areva in half to 10 mg daily. My white blood cell count went back up to low normal. Now it's been 3 months and my body realizes that I don't have enough medication and I'm having my RA symptoms. I started on 15 mg mobic daily but that is not a good long term solution. My doctor said that I have tried all the oral medications and it's now time to move to Biologics. I have always known that this would be a possibility and I have put it off for 10 years. Does anyone have an other suggestions of oral medications to try? If I do move to Biologics, does anyone have experience/thoughts/recommendations for me? I'm nervous to make that jump to Biologics. Any reassurances or things to look out for would be very appreciative. Thank you!

[AgedCrone]

We don’t know your clinical condition Mainstreet, and even if we did we don’t have the qualifications to recommend any sort of drugs.

Going on to biologic drugs is a considered decision by your rheumatologist A Biologic drug that suits one person does not suit another.

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You really should listen to your rheumatologist they train for a long time to try to help us, and those of us that listen to our doctors usually seem to Manage our condition the best.

Your doctor will probably suggest which .biologics are best suited to you ...giving you a Choice of oral, injection or infusion methods.

I chose the infusion method ..one infusion two weeks apart every six months.... I’ve been on that for 4 years & and it was the best choice I have ever made.

[KittyJ]

I agree with AC, your rheumy will advise you on which biologic they think suits you and your condition best. If they are saying that there are no other oral mads that you can take then I’m not sure why you’re not believing them. They really do know more than us 😊 We could all tell you about ours but there is no way of knowing that what works for us will work for you. People have such varying results. Share your concerns with your rheumy so they can take that into account. I’ve been on a biosimilar for 18 months and it has made a big difference to my RA. Let us know how you get on and what you decide to try. 🤞🏻for you.

[nomoreheels]

AC is correct. As your Rheumy has now suggested it's time move on to biologics, then that's his considered professional advice. However, you only mention oral DMARDs. Did your Rheumy not suggest you tried injecting methotrexate at all? If not it may be worth asking him if there's any reason for you not to try this different route when you see him next, as an option to try before proceeding to biologics. Also, the highest dose folic acid he will prescribe. I know you're in the US but here in the UK that would be 5mg 6 days, what I'm prescribed. Both are often more successful if mouth ulcers are a bother on oral MTX.

There's also hydroxychloroquine, that is an oral med. It was my first DMARD before moving onto MTX, generally well tolerated but we each respond differently!

Many with RD do have treatment that includes continued use of an NSAID, I've always had one since I was diagnosed & meloxicam (Mobic ) was one I had for a while & was one of two I was prescribed at diagnosis. It's been changed a couple of times but currently I take etoricoxib, have done for over 7 years. Your Rheumy may have a differing opinion, he'll prescribe as he feels necessary for you.

Once discussed between the two of you I hope whatever is considered the best option works for you.

[Kerensa21]

I know what you mean about feeling nervous but can honestly say I’ve found them more effective with far less side effects than any dmards I was on. Obviously not medical advice 😉 good luck whatever you decide x

[Lolabridge]

None of the meds you call oral worked for me so my Rheumatologist put me onto a biologic. We found one that works really well for me and I’m delighted to be virtually pain free at last.

Do follow your Rheumy’s advice and don’t be afraid to try a biologic- it could be just what you need.