DMARDs for Arthritis Q & A

The information I have gathered about the scary side effects of Arava is not on your site. Are you behind the knowledge curve or is it untrue that there have been deaths? Or untrue that chelation therapy is desirable to avoid birth defects? (I got worried enough to stop taking it.) I was startled to read your listed side effects did not include sudden liver failure or mention the 2 dozen or so deaths hat have occurred. I believe Arava’s own warnings mention this in some way, as does e-medicine .com. It’s long half-life is a danger if liver failure starts. Also you make no mention of the fact that chelation therapy is recommended for those wanting to conceive within 2 years as the drug stays in your system for up to 2 years.

If you have joint stiffness and pain that is pretty limiting but only marginal chemistry profiles (elevated ESR-40 for male, slightly positive RF) should DMARDS be started or should there be more definitive criteria? Physical symptoms for over a year.

45 year old male — I’ve had joint pain and muscle pain /weakness for the last year. The rheumatologist has vacilated on the diagnosis going from suspecting ankylosing spondylitis, MS and now diagnosing rheumatoid arthritis. He wants me to start methotrexate therapy. So far the signs/symptoms are shoulder pain, knee pain, difficulty climbing stairs, severe stiffness, decreased range of motion in hips and sacroiliac joints with pain on movement, hyper reflexes in legs, severe neck stiffness and ataxia or balance problems. The clinical tests included MRI — brain was clear, cervical MRI showed moderate spinal stenosis with bulging disks. EMG was only slightly abnormal but ruled out ALS, Myesthenia Gravis etc. Xrays of hips were normal. Blood work was normal with the exception of continuing elevated ESR (39), slightly positive rheumatoid factor and 1:80 ANA. HLA B27 was negative as well as other immune markers. Previously ran 3 miles + daily for 20 years, but current weight bearing activities are severely limited. Still aerobically active with bicycling etc. Should methotrexate be started or is there a more definitive test that should be done for RA? Dr. says the physical limitations, stiffness, elevated ESR and slightly positive rheumatoid factor are enough to start the DMARD. He also stated that the axial presentation was more in line with AS but the negative genetic marker precluded this. Should Methotrexate be started?

I take 12.5mg of methotrexate per week for rheumatoid arthritis. I also take 1mg of folic acid every day except on the day I take the methotrexate and the day after. In the fall I also take a multi vitiman which contains 0.4mg of folic acid. Is that to much folic acid to take and can it cause the methotrexate not to work as well? Should I also not take it on the day of the methotrexate and the day after?

Over the last year, I have tried all 3 available Anti TNF drugs. I was on Embrel for 6 months, tried Remicade, but had a reaction& had to stop. I have now been on Humira for 6 months, the last 3 months on a weekly dose. These drugs are hailed as ‘miracle drugs’, yet they have all failed to work for me. When most people get such an improvement,why have i have failed to respond?. I can’t take methotrexate, is this why it hasn’t worked? I have heard about other drugs Ritximab & Abatacept which target B cells;Are these licenced for use for RA in the UK?

This is my third time trying to tapper off the Prednisone and this time I am also on Methotrexate. I am reducing the Prednisone and increasing the Methotrexate at the same time. This time the pain and the swelling did not return but my joints are more tender. Could this tenderness get worse or hopefully better the more I reduce the Prednisone?