DMARDs for Arthritis Q & A

In 2002 arava was being petitioned to be taken off the market because of severe liver problems. Have there been new studies about it’s safety? My rheumatologist started me on Arava 3 months ago, after plaquinil didn’t work. We didn’t discuss trying methotrexate first. Now that I’ve stumbled onto this info , I’m worried! I’m 41 with inflamation in hand, feet, and knee joints but have never been in severe pain since I was diagnosed a year ago. My mother has severe RA and has been on arava for 5 years after methotrexate stopped working for her. Should I ask to at least try methotrexate first?

My sister is 37 years old and she was diagnosed with RA 2 years ago.  She was on 20Mg IV Methotrexate, still with mild symptoms.  Her new doctor decreased the dosage to 7.5 Mg PO.  She has become more symptomatic and is now taking 10 Mg SC.  The new doctor does not like to use high doses of Methotrexate and is going to start her in a combination therapy with Arava.  She is young and wants to be pain and symptom free.  She does not have erosions on the X-Rays, but she does have swollen joints including the hands, knees, and ankles.  What therapy would you reccomend?

I have been on Humira for 5 months, & initially had a a great response to the first two injections. Since then it doesn’t seem to have been as effective. As i can’t take Methotrexate i have been increased to weekly Humira injections. I have now had 4 weekly consecutive jabs but still have not felt the same response i first felt with my very first 2 injections. Does this mean it isn’t working for me any more? My last blood test showed a CRP rate of 110, after my first jab it fell to just 23, but has increased steadily since to the current 110 rate. I know it can can take 2-12 weeks to feel full benefit, but as i’d been on 2 weekly jabs for 5 months already, I had hoped for a faster response to weekly jabs? Embrel failed for me & i developed a rection to Remicade & had to be taken off it, so Humira is my last hope as far as Anti TNF is concerned.

I am sero negative RA (Still’s Disease). Because of initially diverse symptoms,diagnosis took a long time. When referred to a rheumatologist, she worked it up pretty quickly. Anyway, have been on methotrexate for several months and symptoms are actually worse. Prednisone taper worked for short time, but symptoms come back. Now on 7.5mg prednisone every AM in addition to the methotrexate. She would like to start me on the biologics and has given me information on the 3. In her experience, she has seen quicker response with Remicade (IV) than the injectables (Embrel and Humira). Possibly “related to the individual differences in tissue absorbtion of the injectables”. Other than that the way the 3 drugs work is pretty much the same and they have the same side effects. In addition to the usual questions that relate to insurance coverage, I am interested to know how your patients consider the convenience factors. That is, IV, 2 hours in the office every 4-8 weeks vs, weekly or bi-weekly injections. Also, have you seen much difference in the 3 drugs and from a cost basis, how does 6 doses of Remicade go up against 26-52 of the injectables.

My mother-in-law was diagnosed with RA a few years ago. For a while she was self-medicating with illegal substances and alcohol and now her RA is so bad that she can not walk or even stand anymore. Her illness progressed to this level within little over a year. My question is…Did her RA progress so very quickly because of the drugs and alcohol?

What is the maximum amount of medication which can be given Subcutaneous?