How many of us are prescribed multiple DMARDS as oppo... - NRAS
How many of us are prescribed multiple DMARDS as opposed to single ie. only methotrexate?
it ooes seem that a lot of people are using comination therapy.. poss some merit.. my personal view... disclaimer here.. is that there are more chances of side effects and they prefer to bolt two or three dmards together than pay for one more expensive ant tnf.. all drugs have nasty side effect profiles... dmards and anti tnf.. we should be the safest that suit each individual!!
scuse typos now how do i down load a spell checler or virtual key board
should say does seem a lot of people have several dmards.. and we should all be given more choice to make judgement for safest treatment for us!!
Hi Gina, most of us are on more than one dmard as even the new drugs such as anti-tnfs and the newer biologics such as Rituximab are still known as dmards! So for instance I'm on MTX and Rituximab so I'm on two.
Take care
mand xx
Hi Gina,
I am on Methotrexate, Sulfasalazine and hydroxchloroquine, have been for 12 weeks now.
Weren't you at a wedding recently? did you last okay in your heels? 
Hi Summer, Just interested ....disclaimer also.... My Consultant gave me an explanation something like this ' the immune system is very clever so even while using the humira I have to stay on 2 other DMARDS they act as sort of decoys???' does that make any sense? I am going to ask her can I come off plaquinil in June, she'll prob say you are doing well on all 3 so why change well we'll see! Also I have to say another Consultant (for my thyroid) was very surprised I managed to get off steroids - God was that one tiring experience, but clear of them now and a stone less! x
Hi Gina, I'm off steroids too and am so glad, the trouble is if I get a bad flare and am waiting for Rituximab funding they always want me to go in and have a steroid infusion. Even though I have 500mg at a time I don't put the weight on having it that way, strange isn't it, still not very good for us though long term.
mand xx
tablets more likely to cause weight gain than injection or infusion with steroids.. im fat and wobbly trying to get down to 10mg just about manging, gina.. if it isnt broke dont fix it if you arent getting any problems stay on 3.. I personally have some reservations about palqunil and the hydroxychloroquine type meds.. disclaimer personal view only.. xx
I am on MTX and Cimzia anti-tnf.. It was explained to me that MTX would slow the progress of the disease by suppressing immune system and anti-tnf blocks the production of imflammation hence you need both.
six weeks in and anti-tnf has made no difference.
Sue x
I thought they both immunosuppressants but anti tnf blanket blocker - but heck who knows or cares if it works!
That's just how I looked at it Gina, didn't care at the time what I was having I just wanted to feel better and the drugs to work!!
Anti-Tnf's work by blocking the action of a chemical called Tumour Necrosis Factor.
Rituximab knocks out the B cells, and the others also work slightly different I believe. Most however are still classed as dmards. I think that's right I'm sure someone will tell me if I'm not lol!
Mandy xx
Hi all!
In England and Wales methotrexate is often used as the first line DMARD onto which others can be added if required. This is known as the "step up" method; additional drugs are given over a period of time to allow each to build up slowly in the system. If side effects occur it is usually clear which drug is causing the problem. In Scotland they seem to use the "step down" method whereby a triple therapy is given at the outset. The problem with this is although in some cases it may be very effective there is also the risk of over prescribing very toxic medications. There is the added worry that if side effects do occur it may not be clear which drug is causing the problem!
I suppose technically all the drugs are DMARDS but more usually its the methotrexate, sulphasalzine, hydroxychloroquine type drugs. The anti-tnfs are Biologics and these are Remicade (Infliximab), Humira, Enbrel, Cimzia and now Simponi. Rituximab, Toculizumab, Abatacept etc., as Mandy says, are all next line drugs and variants on a theme targeting particular cells or actions. These are only used when anti-tnf has failed.
Perhaps this link might be useful uptodate.com/contents/patie...
Lyn x
well done lynn your our advice expert especially from personal experience.. spot on as usual.. xx alison
Thanks Lynn, I knew most of that but could not have expressed it so well. Just reading recently about Simponi, have heard a few in Dublin being offered it apparently monthly injection!
I'm just on 20mg MTX at the moment (with the associated tablets for pain, stomach & side effects, and with some steroids from time to time) and I have to admit to some drug envy at times when I read of other people's intake. Would I be better if my doc had started me on combination therapy? Am I missing out on something? etc etc. And then on other days I want to stop taking any drugs and hope the RA will just go away, so am grateful that I seem to be responding well to MTX alone as I hate having this heap of tablets on the kitchen shelf and wouldn't want it any bigger. But it's so odd that RA is so individual and that the treatment is so diverse - I think we've come to expect that each illness has a pill that will cure it so it's hard to come to terms with the uncertainty of RA and the apparent randomness of the treatments and our reactions to them. Every now & then I have a sort of day dream where my doc says whoops, I made a mistake you've just sprained your ankle and twisted your knee and it'll all be fine next week. I wish. Polly
I did'nt know you could take steroids from time to time? do they work well using occasionally? Helix, how long is it since you were diagnosed. It takes a while to come to terms with the whole thing. The treatment is very diverse, but the best thing is that new treatments are coming on line all the time, and hopefully when patents run out will become less expensive.
Sorry didn't reply - a couple of those squashed days where can only manage the essentials. I'm a newbie, only 6 months or so since diagnosed and yes still coming to terms with it (tho' does one ever get there?). My Doc says that I'm still not stable, and DAS score still above what I'm hoping to get to, and still slowly increasing the MTX. Anyway she has given me steroid shots a few times when the aches & pains are really getting to me - which do help. She is a truly great Doc who seems to listen so I feel v lucky when I read about others' experiences.
Its great to hear you have a good doc that you have faith in Good Luck with treatment, you will get better as you get used to meds and changes.
Hi Gina,
I am on Methotrexate, Sulfasalazine and hydroxchloroquine - I also take diclofenic and prednisolone - shake me I rattle!
Haha! Know that rattle & hum! I keep my paracetamol in a chewing gum tube, feeel like a junkie!
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