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methotrexate AND Sulphalazine

I have RA, hypothyroidism, diabetes type II, CFS/FM. Was tentaivley diagnosed with Lupus in 1997 - but in 2010 had severe illness when my markers (CRP and PV) five times what they should be. Was commenced on methotrexate and this steadily increased to 25 mgs. I still suffer pain but not as bad as before only sometimes severe (usually when stressed)

At review yesterday markers syill raised but are reducing. dr wants to add sulphasalizine to my already long listof meds and then gave me a half dose steriod injection (steriods ups my blood sugars) Not sure what to do, as on so many medications, really confused. not much info given at clinic as they are very busy. Is anyone on both these meds and if so how do you get on with them?/

13 Replies

Hi there,

There are lots of people who are on 2 or 3 of the DMARDS, and this is a well used approach. I'm on 3 (MTX, sulpha and hydroxy) plus a few handfuls of other things, so can be up to 20+ pills a day which is unpleasant. There's quite a bit of research that says that using more than one of the DMARDs is very effective, and gives good outcomes. RA is a tricky beast, and it seems that a mixture of drugs is more likely to keep it under control. But it's also a very individual disease, so it can take time to work out what works best for you. So sorry to hear that MTX alOne isn't doing enough for you, but it's quite usual to mix it with sulpha. Polly


dear Polly

many thanks for taking the time to reply. it is very interesting to see that more than one combination is used and they can be very effective. I suppose its a case of trial and error until a good solution is found. I do worry about the length of time i will be on these drugs and the overall effects it has on the rest of the body.and the other conditions i have, but i must try it - as it could be my answer. thank you polly and i hope that you have found a solution thaa works for you. i will let you know how i get on with it. Regards Gillian


I have recently had Hydroxychloraquine added to Methotrexate (MTX) - my consultant wanted me to try Sulpha but I had already tried it last year and had a serious reaction to it so my GP said no.

The consultant also wanted me to rise on my dose of MTX from 15mg to 20mg but the GP not happy with prescribing this as my liver is already a little over what it should be.

The combination of these two DMARDs seems to be working really well already I am pleased to say although it says that the Hydroxy will take around 12 weeks to make a difference so perhaps it was just coincidence that the RA symptoms died down just as I started taking it? As Polly says its very normal to take more than one disease modifying drug - and for some of the anti-tnf drugs to have the desired effect you should take MTX. I am being tested for diabetes 2 and chloresterol levels on Monday and am probably going to have to take blood pressure tablets and already take levothyroxine for my underactive thyroid. So I too feel like a regular pill popper and hate it but the prospect of falling apart at the seams if I don't is even worse! Tilda x


dear Tilda

Thank you for your reply,I know this sounds strange but I really appreciate you sharing your health issues as i don't feel such a oddity, i sometimes feel that i am always ill and complaining about something, but its not always like that, i am sure that you understand. You have given me a different view point in that thinking of not taking my meds and falling apart is much worse (although i had a bout of depression and stopped taking them including my insulin,for about five days - wasn't good !!) .I will let you know how i get on if thats OK. I very much hope that your bllod tests go well and that you do not need any further meds (or conditions!!). Good luck on Monday - regards Gillian


Thanks. My dad and granddad had late onset diabetes (2) and hypertension so I've spent the last year losing over 3 stone and getting as fit as I can (or as fit as joints will allow). Mostly my RA has been in my hands and wrists so I've been able to walk a lot and I find that by doing this (and with help from drugs and physio) I've kept on top of my RA and I'm pretty sure that I've staved off diabetes 2 but will see! Not managed to keep blood pressure down though - think that it's just in the genes as I've tried everything possible there.

I'm sure you are aware of this but there's an awful lot you can do for diabetes 2 through diet? I believe the low carb diet is particularly effective? I also find that walking is my cure for the bouts of depression I've had since the RA started.


It's hard to adjust to taking pills. I used to hardly ever take anything, and I think still had a tub of aspirin dating from the 80's that I hadn't finished. And now I've had to get used to rattling with them, and constantly having to be aware of what you're running out of and being in and out of chemists to collect prescriptions is really irritating. But all I have to do is 'talk' to some of the folk on here who've had RA since before the drugs were developed, and who are really suffering the results, and I feel so thankful to have them. It's rough, and you have to think about stuff you've never bothered with before, and I'm getting obsessional about eating properly - but I think it's helped me to get to the point where I'm not trying to fight this, but learning to live with it. I've got RA, and that's that. (well most of the time, there are still the bad why me days, and the days where I think it was a mistake, but that's another story). Polly.


Love your phylosophy Polly, you're not trying to fight it, you are learning to live with it! Yes. That's the goal, to live as full and normal a life as is at all possible, and I'll add, to do whatever it takes to get to that goal!



I also take sulpha and plaquenil - I inject mtx and am on Anti-TNF (cimzia) - I too have a thyroid problem, but touch wood that has been ok.

Stress is a major part of my problems at the moment and I have just had to have a big dose of steroid to help me get through this difficult patch. I am also on anti-depressents and sleeping tablets along with pain killers.

I wonder what the effect of all these drugs are having on me, but I am lucky that I have a good relationship with my rheumy nurse, consultant and GP so they all 'talk' to eachother and recognise my concerns.

It does take time though and I know I was impatient at first, but slowly I have noticed a change.

I do hope this helps a bit - and may be next time you are a clinic, make a point of mentioning you worries - I record everything in a little note book, good and bad, and write down any changes that occur at my appointments, so I dont have to remember!!

Take care and I hope things settle down for you soon

Pen :)


Hi Bodicea,

Have chatted to your GP about the depression you mentioned? you have a lot to contend with healthwise with several illnesses to deal with. Please dont stop meds without Drs permission stopping thyroxine and insulin could be very problematic as Im sure you are now aware?!. It can take time to get the drug balance right but things will improve xx. dont hesitate to contact me if I can help.

Alison x


Dear Alison, many thanks for your reply, i chat regulalry to my GP as i see him monthly, in 2000 i suffered a severe depressive episode at work and it has left me with PTSD. i do still have days when i don't "think straight" if that makes sense. Even telling my GP doesn't change anything, nothing gets done, i even asked for a referral to a therapist, he just said oh theres such a long waiting list... and did nothing. so i do get dispondent at times. myblood sugars are really hig at the moment due to the steriod injection and i an feeling really unwell, but rying to cope with it all. but thank you for your support and advice, and for saying i can contact you if i need to - that means so much as i do not have anyone to talk to about all this,so as you can guess -its hard. but thank you - i feel much better knowing someone is out there -even just listening to me. All my love Gillian xxx


Hi Bodicea

As others have said, combination therapy is quite common and is recommended in the NICE guidelines for RA. We have an article on it that might eb of interest:

Kind regards



Dear Victoria, many thanks for your reply, the article is very interesting and makes me feel a lot more informed. also explains the different combinations they recommend. Although i would rather leave out the steriod therpy as this does not agree with my diaetes and my blood sugars go sky high.once again many thanks for a great link i shall be printing it out and adding to my "health file"

Take care

Gillian xx


Hi Gillian,.A Therapist or pyschologist can be very helpful, they arent judgemental( I saw a pain management pyschologist) and you can express your hopes and fears, Im really sorry to hear that you have a major depressive episode.

Steroids can be a Useful bridge but I can see that your blood sugar worries you, are you taking and diabetes medication?.

and you have received advice from a diabetic clinic/ nurse on best diet strategy etc? x


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