Took the Methotrexate, Sulfasalazine, Hydroxychloroquine today as start of aggressive treatment. Do we all get this at start?

[Rockpool60]

[Hidden]

Hi,

No, from what I've seen on this site it is not standard however I believe this is called the 'Step Down' method (Triple Therapy), where you start all 3 dmard's then slowly cut down to what dosage suits, England they use the 'Step Up' using one at a time...

Scarier as you are dealing with all 3 at once but at least hopefully one of these meds will work for you and your RA/Pain will be under control quicker.

If I was given the choice now, I would 100% choose the aggressive treatment.

Saying all this, there is a scottish member here Tilda (I hope you don't mind me mentioning your name!!!) who has not been treated this way.

How are you getting on so far? did you stare at your tablets for ages with an attitude like I did before taking them

[Rockpool60 in reply to Hidden]

Hello Wiliby yes I am in Scotland. I got a jab of steroids on my bum to keep me going until they work which is about 12 weeks. Yes lol...I spent the last few days looking at them with contempt like being told you are being induced for your baby..does that sound daft? So just feel really tired and slow..and still quite terrified about it all. Thank you I don't mind...I wonder if how she gets on with them. Thank you x

[Hidden]

Sorry, Tilda was just given 1 to start with, It was me who had all 3 like you.

They didn't work for me but started a anti-tnf (biologic) in August which worked and now in whats called 'chemically reduced remission'

If I had to try 1 out at a time then goodness knows how long it would have taken to get under control.

Hehe totally get the being induced lol, I felt like I was walking to the gallows (to be induced and taking first meds!!)

keep us posted x

[LuckysJoy in reply to Hidden]

I am on 4 Different ones, and I am in England

[Rockpool60 in reply to LuckysJoy]

Did you have terrible side effects? take care x

[LuckysJoy in reply to Rockpool60]

They gave me for celebrex and hydroycloroquine (think spelling right) and I was on that for 6 months and they have added another for the burning and tingling in hands and feet and creepy crawlies for the Fibr, and I started MTX a month ago, I only had side effects the fist week and it was following day Headach (awful) second week same but less intense, by third week Didnt have from MTX I take my Folic acid the next day, I will say I take my MTX before bed, I think that has helped, Good Luck

Lisa x

[salem974]

Usa here and I take Methotrexate, Plaquenil, Leflunomide and prednisone. My Ra is still progressing and Dr wants to start either Enbrel or Cimzia. Due to the cost and no insurance that will have to just wait and hopefully my Ra will not get to bad.

[Rockpool60 in reply to salem974]

Are you in America ? That must be so worrying for you. I hope they get you on the ones that you need very soon x

[LuckysJoy in reply to salem974]

I really Feel for you, I lived in the States on and off in My life, I grew up with Severe chronic Migraine, where I would have to go to hospital each month for treatment, Until they caught on years later Just give me Immitrex injections for home, (some of the time I was On BCBS and Was blessed to do so. $100.00 for two Injections when You dont have insurance, BUT the Hospital bills, when I had no insurance the last 2 years I was there before I returned home to England, Wow How awful Thousands and Thousands in costs, And they way they charge more for Cash patients, than they charge if you have insurance. Wow, I am so grateful to be home, and be taken care of, Just in time for the RA and Fibro to rear its head so severely.

[helixhelix]

I'm on the same three - MTX, Sulpha and Hydroxy. I'm in England so I started one at a time, and it took over a year to build up the doses. I wish that I'd started all 3 at once as then maybe I wouldn't have the damage to my joints that I do now. It's a bit of a scary heap of pills as I'm on quite high doses now, but better that than joint damage. Expect to feel a bit tired to start with as your body learns to cope, and be careful in the sunshine until you find out if they've made you sun sensitive. Polly

[Rockpool60 in reply to helixhelix]

Hi Polly...It is all very scary and feel horrible. I have factor 50 for the sun my friend who has Lupus has the same tablets as me and warned me about the sun. Take care x

[Hidden]

Hi Tilda here. I did answer this but as was in house in a Welsh Valley on my iPhone the signal was too poor for it to load. Now in coach to Cardiff so will try again.

Yes I'm on 2 DMRDs now after 6 months of just MTX. Stepping up slowly and all by myself with only the support of my GP - having researched all the meds and chosen Hydroxychloraquine by myself too (I live in Orkney where the Rheumy service seems to be pretty damned thin putting it politely!)

I feel okay mostly although a bit achey still but my ESR (inflam marker) is now back up to 62 so I'm wondering if my drugs are only masking the pain and disease activity perhaps?

I think that Williby, Polly and the others are right to say that you are lucky to be on the aggressive 3 DMARD step down approach and should look at those meds with a degree of respect and even admiration if possible? They may save you from the damage that early RA can otherwise do.

I worry that my joints are sustaining damage all the time on this soft slow step up approach. And yes Orkney may be ambivalent about this but it is part of Scotland and my rheumy is based in Aberdeen where the step up approach seems to be favoured. Good luck to you. Tilda x

[Victoria-NRAS Partner Moderator NRAS]

Dear Rockpool

Combination therapy with 2 or more DMARDs is fairly common and is recommended in the NICE guidelines for RA. We have an article about combination therapy on our website, which may be of interest:

nras.org.uk/about_rheumatoi...

Kind regards

Victoria

(NRAS Helpline)