Medication choice?

[dottydoris28]

Hello. I've not posted before but read all comments with interest. I was diagnosed initially with PMR in October but it has now progressed to Polyarthritis and Rheumatoid Arthritis since end of February. I was taking 10mg Pred which have reduced gradually to 4.5 and 3.5 on alternate days. Still have pain but much better than it was at the beginning. My rheumatologist wanted to start Methotrexate but after careful consideration I have decided I don't want to put my body through the side effects and regular blood tests required. I have been sent brochures on Sulfasalazine, Leflunomide and Hydroxychloroquine. Does anyone have any experience of these drugs please? I know I have to take one of them and at the moment Hydroxy seems the best choice. Any help appreciated please?

[PMRpro Ambassador]

It really isn't what YOU want - it will be which works for you. Leflunomide also requires blood tests and hydroxy means eye monitoring. All of them have their own side effects and everyone responds differently - some people don't have the slightest trouble with anything, others see every adverse effect on the list, or so it seems.

But to get much advice on those drugs you need to go to an RA forum as none of them are commonly used in PMR because they don't work for it. They are for inflammatory arthritis - a different thing altogether.

[dottydoris28 in reply to PMRpro]

Thank you for your reply.

[GOOD_GRIEF]

Methotrexate is the gold standard for treating Rheumatoid Arthritis, often in conjunction with Pred, until the MTX hits therapeutic levels in the body and RA is controlled, which takes anywhere from 6 weeks to 6 months depending on the intensity of your RA.

MTX is a Disease Modifying drug, which means that while it does reduce pain, that is mostly because it actually reduces the deterioration of the joints produced by RA. Pred reduces the inflammation, but does not prevent joint damage. It is primarily prescribed in the early course of RA, and during flares, to clear up inflammation and provide relief from the accompanying symptoms. It does not change the course of RA. MTX does.

Every drug has its side effects, some merely unpleasant and others requiring monitoring and amelioration. Most RA sufferers do quite well on MTX once they have adjusted to it. The important thing to remember is that is slows down the disease, often putting patients into remission for long periods, and reduces the damage to the body caused by RA.

The other drugs you list are sometimes tried when the patient cannot tolerate MTX, come with their own side effects, and are often less effective in modifying the disease itself.

Do switch over the the Rheumatoid Arthritis site, where there is a wealth of information on RA, MTX, Pred in RA, and other treatments, including the biologics.

Wishing you the best...

[dottydoris28 in reply to GOOD_GRIEF]

Thank you for your reply. I work in a GP surgery and many, not all, patients on Methotrexate have / are having side effects. I also have other health issues so am considering the options. My rheumatologist who I have only managed to see twice because of Covid19 has just retired so bit in limbo really.

Much appreciated.