Re: need advice; need more treatment?

[Guest guest]

Joanne, the MTX could still be increased. But if you haven't noticed any

difference at all since October, that's not a good sign. The average

onset of action of MTX is about 4 to 6 weeks.

Have you told your doctor that you aren't sensing any improvement and

would like to modify your therapy? I think being direct is the best

approach. Just ask.

Perhaps you could add one of the TNF inhibitors? (Enbrel, Remicade, or

Humira)?

If I were in your situation, I would not fuse my finger joints. What

about replacements?

I'll tell you where to go!

Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org

[ ] need advice; need more treatment?

> I've posted before about DMARD's and trying to understand

> the rationale for using one drug over another...

>

> I've been on MTX since mid-October and currently on 0.7ml

> injected once per week with no improvement. I have gradually

> been increased from 0.25 in the beginning and had a slight

> drop in dosage at one point because of problem with labs.

> Then they added Leukovorin which quickly cleared that up.

>

> At this point I definitely feel no better and am losing some

> function. I was not working when I started MTX but I am now,

> and I have difficulties there as well as at home (dressing,

> food preparation, etc).

>

> How much time do you give a drug to show some positive effect?

> When to add another drug? I really like my rheumy... how to

> persuade him that I am ready to give up on MTX and try something

> else? In the past, the only med that helped was Placquenil,

> but then I became allergic.

>

> I am diagnosed with severe inflammatory arthritis. RA is

> negative but I have the typical nodules seen in RA in my

> fingers but not on the knuckles, tho the knuckle joints are

> shot on x-rays and qualify for joint replacements. If I can't

> get a drug for reasonable pain relief, the next step is more

> fusion surgery on fingers, which I'd like to avoid or at least

> postpone for awhile. I am not liking the idea of fusing my

> fingers which will permanently limit function! I've already

> had two joints fused in my right thumb last spring.

>

> What would you do? Anyone here have finger-joints fused?

>

> Joanne