Which combination of dmards would be better?

[peridotlouise]

Sulfasalazine and MTX or Sulfasalazine and Hydroxychloroquine?

I am on sulfa atm and my rheumy suggested adding another med. I'm scared about taking MTX but obv want to take what would be better so which works more??

[Hidden]

Hello,

I'm starting to learn with R.A. that it's very individual and really (and unfortunately) a case of trial and error. I was diagnosed about a year ago and started off on prednisolone for 12 weeks and MTX. I didn't see a huge improvement after I weaned off the steroids and so hydroxychloroquine was added into the mix. This combination did not work for me and I just started on anti-TNF last week so fingers crossed for this.

What you have to remember is these are strong drugs which I do not believe they would not have you taking for if they didn't hope they would work.

They could very well work for you. Read up as much as you can and write down questions to ask your consultant / nurse when you're next in. Be careful where you're researching as these drugs are used in hugely different doses to treat some scary things I.e. cancer, malaria etc... x

[helixhelix]

Hello

Everyone's different so there isn't a single recipe. However, MTX is often said to be the gold standard treatment, and often the first one tried. It is a strong drug but lots of people find it ok, so don't be worried. I found that I got headaches and so in for first few weeks but since then it's not been too bad. And you get regular blood tests to check everythings ok. And if it doesn't work or doesn't suit you then they'll try something else. Anyway I'm on all 3 - MTX, hydroxy & sulpha - which is suiting me fairly well.

[Gina_K]

As has been said everyone is different , a combination of dmards has been proved to be most effective. I am on 200 mg plaquinil ( used to be x2) methotrexate 17.5, and a bi weekly injection of Humira, and that has worked for me.

Regards, Gina.

[allanah]

Hi, i have had different drugs given to me, and different doses of the drugs. Also as Methotrexate made me feel sickly they changed that from by mouth to injection. So it seems that they will try the different drugs in different ways and see what the results are by how you feel and how your blood tests are so you feel better.

Also some of the drugs help by preventing damage that otherwise may occur in your joints which is a huge long term benefit. As Gina says everyone is different and the drugs work quickly for some and a bit slower for others. Talk to your nurses or the NRAS helpline as they are helpful and give sensible advice. Good luck with your meds. Axx

[rheumatoidymummy]

When I was diagnosed just over 3 yrs ago Methotrexate was described as the 'Gold Standard' for treating RA by my Rheum wanted to get me on it ASAP to limit joint damage. I take 20mg a week along with Hydroxychloroquine and Sulfasalazine with no real side effects.

It seems to be a case of trial and error to get to the right combination - I still don't think this combination therapy is enough to keep my symptoms under control but I don't qualify for anti-TNF treatment. Someone I know injects MTX and she says that gave her more effective relief than the tablets - I may try that.

Hopefully your rheum will find the right mix for you soon.

xx

[Trish53]

I'm now on max dose of Sulfasalazine only, as I had really bad side effects when MTX was added in at the end of last year, but it's not completely doing the job (70% effective in my case), although don't have too much in the way of side effects either! My RA consultant says I need to have another go with MTX in the near future (perhaps starting with a much lower dose to see how much by body will take), as it is the 'gold standard' and has to be taken for 6 months and failed, before you can be considered for the very expensive biologics. Perhaps that's why they didn't start me on Leflunomide as planned? I think it's just trial and error regarding what suits but I suspect that if the cost wasn't an issue, we'd all be quickly transferred onto the biologics, which seems to be the ultimate drugs when all else fails! Whatever is added in for you, don't worry to much about other people's experience of side effects, as yours may be totally different, as I've found out.

x