When an RA flare is no longer a flare because it never stops... How long, in your experience does Metoject take to work?

[Brushwork]

I used to be comforted by the knowledge that a flare would eventually abate. Mine used to last a few days, then maybe a week or so... Now, in the whole of my left wrist and hand it is stuck, it has been there for almost 2 years only broken by steroid intervention or biologics.

When the pandemic hit and as lockdown was announced I was between meds. I had a nasty allergic reaction to Benepali. What to do? The Rheumy team were really good - I was given options, but it was advised that I don't start another biologic or anything further up the scale while this virus was around. So... I had taken Methotrexate orally and had a terrible time, I would be ill and not able to function for 3 days each week, it affecting my head as much as my stomach and lead to depression. I asked if I could tentatively try Metoject - I was amazed that I had virtually no reaction to the initial dose of 7.5ml so increased to 15ml and very mild nausea. I am only 4 weeks in and there is little affect on my joints yet. I am hopeful - anybody here experienced a rapid joint response or a very slow response?

I have prednisone in my medicine cupboard, I don't want to take it, so am trying to wait it out with Metoject and Naproxen.

[Dspooky01]

It took about 6 months for me for MTX to fully work, but I did see improvement after about 3 months, so hang on in there and it’s good that you’ve only got mild side effects (as have I).

[Brushwork in reply to Dspooky01]

Thank you, that’s helpful.

[Dobcross1]

MTX took about 14 weeks to start to work for me - the waiting is really hard I know. I had De Quervains tenosynovitis in my right wrist which basically might the wrist joint on the thumb side was 'stuck' and I couldn't move my wrist. This went on for months until the 2nd steroid injection into that area released it (thank God!). Its left my wrist a mess as the muscle has atrophied and the skin is thin and forever bleeding - but I'd make the same choice again as the wrist moves well now. I thought I'd mention this just in case any of it is relevant to you - apologies if not.

[Brushwork in reply to Dobcross1]

Thank you. I hope it doesn’t get that bad.

[Lolabridge]

If a flare continues for that length of time surely it's not a flare but a sign that the medication is not working correctly for you. I suggest you contact your rheumy for a discussion about changing your medication and perhaps a biologic is what you need now.

If you heard the consultant Rheumatologist from King's College Hospital speaking on the latest NRAS Facebook live session he said that some of the biologic drugs seem to offer some protection against covid-19 and that uncontrolled RA is not good. So don't automatically rule out considering starting a biologic and continue to suffer.

[Brushwork in reply to Lolabridge]

I’ve struggled to find a Biologic that I’m not allergic to that works.

I might give it a couple more weeks and then call the Rheumy again.

[Brushwork in reply to Lolabridge]

I fully realise that my RA is not under control. I have spent the last 2 years going from one med to another in an effort to find something that doesn’t make me very ill and that works.

Kenelog injections helped, but they are no longer effective.

Just a bit of a trial right now...

[Lolabridge in reply to Brushwork]

I have found Rituximab made a huge difference to me but it’s the one drug your Rheumy will not want to give you at the moment.

[bpeal1 in reply to Lolabridge]

I had Rituximab two weeks a go so don’t necessarily rule it out as an option.

[Brushwork in reply to bpeal1]

Interesting. The idea of it scares me. How do you get on with it? Reactions? How long does it last?

Sorry, just mixed information about it.

[bpeal1 in reply to Brushwork]

Personally it is the best treatment I’ve tried. I always feel a bit groggy the day after it but apart from that it’s fine. I’ve never had any trouble with infections. However, everyone is different and different things work better for different people. Unfortunately it is very much a case of trial and error to find what works best for you. I would have a discussion with your rheumatologist. 4 weeks is not long enough to decide if MXT is working or not but if the side effects are too bad it’s worth having a discussion. All I was saying was don’t rule anything out as rheumatologists seem to be less worried than they were even a few weeks ago.

[wishbone in reply to Lolabridge]

Agree, when my RA was out of control the debilitating pain was almost relentless for approx 10 weeks and damaged my lungs in the process until it was brought under better control. Even then it was poorly controlled for the next couple of years and the pain continued though not as bad and varied in severity....bad times! Thankfully my RA has been better controlled this past year.

[bubblyalex]

What about adding in codeine and paracetamol as separate meds while you wait for Metoject to kick in? Co codamol does not achieve the same pain relief as taking them as separate. I’ve heard others say that and certainly it has been true for me. It also means I take the codeine only when I need it... all the time at the moment but I am trying not to have to go up on the Pred dose again.

[Brushwork in reply to bubblyalex]

Never tried that.

Pain, is not much of a problem

[springcross]

HI Bw. I was told that the Metoject would take up to three months to work and that was certainly true for me, if not longer. I started off on 15 mg I too had mild nausea a few days a week) but was increased beginning of March to 20 mg (still get occasional nausea) although I feel I could maybe have more but really don't want to. Give it a while longer as it's only been four weeks and you may well find that in a few weeks time, it is beginning to work for you. You can always check with your rheumy nurse in the meantime. Good luck. x