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Date: 21.03.2013
From: Heather

Subject: How do you make a decision about treatment options?

Background is this:
Had JIA from 8-14 years.
Diagnosed with RA at 28 and was put on suphasalazine which gave me awful side effects so I've been on hydroxychloaquine for the past 5 years.
Recently had several horrible flare-ups, so I was given steroid injections (did nothing) and am currently on a 3 week course of Prednisilone (due to finish end of next week).
Rheumy has suggested 2 possible treatment plans:
1. Manage flare-ups with oral steroids on an as and when needed basis
2. Go on to Methotrexate.
Both options have pro's and con's and they are keen for me to make my decision by my next appointment in June, but how do you make that decision? Has anyone else been in the same situation?
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Date: 21.03.2013
From: bsk

Subject: Re: How do you make a decision about treatment options?

Hi Heather,

I have a combination of anti tnf and steroids and it has taken quite a while to get the balance right - a very fine one in my case.

I didn't get on with Mtx and it didn't help much. Steroids are great but not wonderful side effects. I have got cataracts from them for a start.

You do have the option of going onto anti tnfs if you have tried 2 dmards. I don't know if you want to go down that route but it's worth doing a bit of research.
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Date: 21.03.2013
From: Colin W

Subject: Re: How do you make a decision about treatment options?

hi Heather ,

give Methotrexate a go , can be a realy good drug for RA , not everyone gets on with it but some of us have been on it a long time & get no side effects , folic acid sort most the side effects

steroids are not the best , along with the side effects you can get problems coming off them with a big flare but the other long term risk like osteoporosis

anti tnfs are good but they like you to try Methotrexate first + you have to pass a DAS28 test
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Date: 21.03.2013
From: Heather

Subject: Re: How do you make a decision about treatment options?

Thanks for the advice guys!
I think the main thing about MTX is that I'm worried about the side effect, what with being so ill with sulphasalazine.
My grandmother had osteoperosis, so I'm already in the 'at risk' category, without having the added bonus of steroids increasing the risk.
Rheumy said I wouldn't qualify for Biologics at the moment. I'm not sure why - I guess because I've not tried MTX yet...
Rheumy said that 60% of people improve on MTX and that figure goes up to 80% when they take MTX with a biologic. Anyone else heard that?
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Date: 21.03.2013
From: bsk

Subject: Re: How do you make a decision about treatment options?

Hi Heather,
a lot of people don't have side effects on mtx. I've got one friend who never complains of anything. You can always come off it if you really don't like it and then at least you would have tried it prior to be assessed for biologics, if that is needed.
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Date: 21.03.2013
From: Colin W

Subject: Re: How do you make a decision about treatment options?

National Rheumatiod Arthritis Society has a lot of information about the drugs

http://www.nras.org.uk/help_for_you/publications/publication_detail.aspx?id=a0B80000008XzmxEAC
this is thier booklet about the new bio drugs + they have good information about other drugs + the Disease Activity Score ( DAS 28 )

MTX is a cancer drug & they found people with RA improved on it when being treated for cancer , but we take a lot lower dose so when you look at the side effects it states some that are not relevant to RA , a lot of us on it dont get any
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Date: 22.03.2013
From: Tara

Subject: Re: How do you make a decision about treatment options?

Hi Heather
I am on mtx and its helping me a good bit still have problem s daily with joints but I was a lot worse on 25 mg weekly I don't have any major side effects just the thoughts of taking makes me feel ill but it passes my hair got lighter but not that you would notice
I have an awful fear of steroids , I had a family member that was on steroids for many years and she just couldn't get off them she bruised really easy just rubbing her eye would give her a black eye she had many minor strokes threw the years but unfortunately she had a major stroke a few years back and passed away
Now saying all that steroid have a place as a very short term bases just to get you over a bad flare I have had steroid jab and very short term oral steroids no more than a week , my consultant wanted me to take a six month script in January but I said no took them for a week just to see me threw
Any way sorry for the rant but they really make me nerves
Feel better soon
Hugs
Tara
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