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Rank: Member
Groups: Registered
Joined: 6/14/2010
Posts: 23
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I am recently diagnosed with RA (Feb 2010, but symptoms from Dec 09, possibly even before) and the only thing that is giving me any hope is the ‘therapuetic window’ for early RA and a chance of total remission, as suggested in this article www.arthritisresearchuk...._-_spring_20091.aspx#nonMy rheumatologist said this 'window' is 12-18 months, but it could be as low as 3 months according to this article: www.disabled-world.com/h...hritis/r-a-prognosis.phpRight now, I oscillate from total despair to hope that I may be ok and continue to be the active, lively, friendly young father of two small children I have always been up until a few months ago. I am still working, as I am the main earner in the house but cracks are beginning to appear. I don't want to go downhill. As a self employed person, if I do not work, I do not get paid, I have no rights. If word gets out that I am ill, people do not have to continue to employ me. Psychologically, I am struggling. The past few days I call 'wipe out days' - where I can bearly do anything but rest. I am dog tired and shutting myself away too often - which is not me really. What does not help, is that despite the medication I am on: Methotrexate to 20mg per week as of 11/6/10. Prednisolone 10mg per day (but I have also had major doses injected in first few months), Folic Acid 1 per week, Salfasalizine 4x500mg per day, Adcal-D3 2 per day, Alendronic acid 70mg 1 per week. My Rheumatologist suggests I continue with this for another month, if I still have a high DAS (5.7), then they will start the funding applications for Biologic drugs. This can take up to two months. This is far from ideal! The hospital is saying I am on ‘combined therapy’ but I am on two DMARDs simultaneously. However, the kind of ‘combined therapy’ talked about in the first article (above) includes one Anti-TNF drug. I am scared of having permanent damage because the right medication for me is held up because of NICE protocol & finance! Has this happened to any one? How can I prevent this? What did you do? I live in London. Am I subject to the 'post code lottery' & ‘reality not living up to the ideal’ as one MP said in this report: http://www.nao.org.uk/pu..._people_with_rheum.aspx
Where can I go, that has an effective multi-disciplinary approach, where the reality does match the ideal, as I want a second opinion. Please help if you can. Finally, I have read that drugs are the only cure for RA, but thinking of the film Lorenzo’s Oil, having successfully been treated by a chiropractor for years & having found this site http://www.drdahlman.com...umatoid-arthritis.shtml and this one: http://www.jandevrieshealth.co.uk/ I keep an open mind that alternative therapies, nutrition and diet can contribute somewhat to our wellbeing. Has anyone tried and stuck with Dr Dahlman or Jan de Vries approach? What Dr Dahlman says relating to ‘leaky gut’ does resonate with me as about a year or so ago my doctor put me on Omeprazole – that problem is overshadowed by RA and I’ve stopped taking meds for anything else. I think ploughing ourselves with meds for this and that really can’t be doing us any good. But that’s a personal thing… Does anyone know the cheapest place to get top quality fish body oil capsules 1000mgs and whilst in Spain recently I was able to buy Omega-3 milk. I cannot find it in the UK. Apparently, Omega-3 can help with inflammation, Omega-6 does not. I think that’s enough…in the vein/vain? hope someone is still reading this… Very best to you John
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Rank: Advanced Member  Groups: Registered
Joined: 2/18/2010 Posts: 1,098 Location: farningham kent
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Hi John
Really sorry hear that you have been diagnosed with RA. I am still relatively new to all this too, and do not feel confident to give you advice on much of what you have said, but we have some very understanding and
knowledgeable people here who I m sure will be able to help you.
I do however now buy my Omega 3 triple strength 1360mg, online through Holland and Barrett, I don t know if they are still on offer but only paid £ 8.99 for 60, have paid a lot more in their shop .
Hope you are able to get things sorted, a little very soon.
Take care Julia
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Rank: Advanced Member
Groups: Registered
Joined: 2/26/2010
Posts: 271
Location: hampshire
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Hello, John, welcome to the forum, but sorry that you have RA. I too am fairly recently diagnosed and dont feel in a position to advise you. I was like yourself, shell shocked at the diagnosis and very confused as to what medications I was taking and the effects etc. This forum has been a total god-send there is always someone you can talk to. Also with the NRAS membership you can ask to have a one to one with a mentor who themselves have RA. I had this one to one and found it invaluable to be able to talk to someone who had the same condition and knew all about the meds etc.
Hope this helps and good luck!
Heather
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Rank: Advanced Member
Groups: Registered
Joined: 12/4/2009
Posts: 2,127
Location: Thornton Cleveleys
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Hi John Welcome to the forum John but sorry to hear you have RA. I will post you a full reply and try and answer some of your enquiries tomorrow. I'm really tired now, end of the day for me and won't be able to do your post justice! Someone else might be able to offer advice in the meantime. What I would say is that from my experience you do seem to have been given appropriate treatment. Biologics are great for those who need them and but they're not necessarily suitable for everyone in the early stages of disease. Other treatments can be equally effective. I'm Lyn, by the way, diagnosed with sero-negative RA 22 years ago and run the gamut of medication and had a number os surgical procedures. I'm married, have four children, and live in Thornton Cleveleys on the Fylde coast, Lancashire. I will get back to you tomorrow but please try not to be anxious ... stress can add significantly to the RA dilemma. You are in the right place to get lots of helpful information and meet and chat with people in a similar situation. Catch up tomorrow John, Lyn x
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Rank: Advanced Member  Groups: Registered
Joined: 4/20/2010 Posts: 1,749 Location: Somerset
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Hello John
Sorry you have RA join the Club. It is a horible diease.
I am relativley new as well as as per the other girls above you will get great advice from
'someone', as I do not feel qualified myself and as said previously I have found this site great and the powers that
will have a one to one with you .
~Good luck Rose
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Rank: Advanced Member  Groups: Registered
Joined: 12/3/2009 Posts: 561
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Hi John welcome , im Sophie 35 had Ra for 15 years also have Lupus, when i was first dx my mum took me to see Jan de Vries he put me on a special diet and i had to drink certain things which were horrible and salt baths it was a long time ago so cant remember every thing ! sorry to say it did not work for me, i just could not do it for any longer and in the end i remember not being able to get up off the couch and just crying then i had to take the medication the hospital had given me Naproxen and Sulphasalazine this worked after a few months and i was very happy and able to work for 8 years after that, hope your meds kick in soon ,
Sophie .
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Rank: Advanced Member  Groups: Registered
Joined: 12/3/2009 Posts: 3,157 Location: Huddersfield
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Hi John,
Welcome to the forum but sorry you have RA, it must be especially hard for you with young children.
As Lyn says, do not despair, it's early days yet. Combination treatment does not always include anti-tnfs , especially at the start of treatment. This is not just because of cost, there are NICE guidelines, but they are strong drugs and can do a lot of harm as well as good, so it's best to try the standard DMARDs first.
Mtx is the gold standard treatment for RA, and mixed with the sulpha is a very good combination which a lot of people find very effective.
Some people on here are finding their RA very responsive to just one DMARD, but we all react differently to the drugs so it is a case of trial and error to find which ones suit you.
As for alternative therapy, by all means use it alongside the conventional drugs but you MUST tell your doctors if you decide to take any of these,to make sure it doesn't clash with what you are taking.
As a substitute for conventional drugs , alternative therapies may help the symptoms but will not prevent joint damage.
Hope all that helps. Looking forward to getting to know you.
Doreen xx
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Rank: Member  Groups: Registered
Joined: 2/21/2010 Posts: 16 Location: preston
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hi john,
i hope you will find some of the answers you are looking for from this forum. RA is a horrible disease but i really belive that a positive outlook helps in how you deal with it. Remission is possible but from my experience it has a mind of its own!! i was diagnosed at 14 (30 now) and responded really well to low dose sulphasaline for abour 8 years. then i had a bad relationship break up (there is a theory that our body responds to emotional problems in a physical way) and had a huge ra flare up but again was eventually controlled with sulfalsaline and mtx. have had a couple of ops and since having our baby will need another one as carrying him has knackered my elbow again!! i see a homeopath, acupuncturist and have regular massages just for a bit of me time. i've looked into jan de vries and went to one of his talks but honestly the diet is so extreme i think it would make me miserable following it!! but i do think there is a place for comp therapies and take flaxseed and fish oils - try and get fish oil without vit a and one that has been treeated to remove pollutants like mercury. expensive around £10 for a months supply but was recommended when preggers. i've just run out and can't remember the name of it - dr something norwegian sounding? in a blue box. could only find in independent health food shops. (which tend to be better placed to give good advice). Swimming and gentle yoga or pilates is really good and maybe try some positive meditation - as someone else said stress is terrible fo ra. don't ever be afraid to challenge your consultant if you don;t agree with them - you will be a better expert then them. but there are other combinations you can try before going down anti tnf route - i found gold really good but got fed up with traipsing to hosp to have the injection. do you have mtx by injection as there are reports that this is more effective then tablets and you can gove them yourself at home. try and find a local support group in your area which i found really useful and/or use the telephone vol scheme through nras as just talking to someone is very therapeutic.
you will still be able to run round after your kids, you may just have to adapt and compromise more - my little one knows he has more floor time play with me and his daddy is the one who can swing him round and round!! there are lots of gadgets which can you round the house too. and just rest when you need to, having ra is like having kids, you have to adapt to a different and sometimes slower way of life - but all the good stuff is still there!!
katie
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Rank: Advanced Member
Groups: Registered
Joined: 12/4/2009
Posts: 2,127
Location: Thornton Cleveleys
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Hi John Back again! When my body says stop ... stop it is!! A most difficult situation you find yourself in and a place we have all been at some time so understand your worries. Firstly try not to let the diagnosis get you down, it is important in the treatment of the symptoms that you try to remain positive as stress is understood to lead to 'flares' and ongoing problems. Yes, you will be anxious because of the implications that RA brings with it but each of the problems can be dealt with. It is a long term disease, it is not curable, but it can be very well controlled and can sometimes be brought into remission. Each one of us is very different and likewise the disease affects us differently. We all react to the treatment in different ways therefore it has to be personalised to match your requirements. The fact one person in Cumbria has Enbrel and another in Cornwall has Gold injections is of little significance; what matters is the course of the disease and how it responds to the medication you are given. You have been prescribed the gold standard treatment of Methotrexate, but it can take 3 months or more to kick in and you have to be patient. If it means taking time off work (I understand that time off is lack of earnings for you - do you have insurance to cover you?) it is better to do that now and give the meds chance to work than struggle on with joint problems and fatigue and make matters worse. Combination therapy with short term steroids is an excellent start but you have to do your bit too! NICE have guidelines for treatment. In order to be considered for anti-tnf you must have failed on two DMARDS. They are not to be considered lightly though as once you get to this stage you could well find yourself on the drugs for life. A DAS of 5.7 is not particularly high, but two assessments are done about a month apart before anti-tnfs are considered. Two months really isn't long in the overall picture of a lifetime disease and not something that should be rushed into. It is possible that for you the disease could just calm down of its own accord and to rush into potentially very toxic life changing medication could be disastrous. Combination therapy can be any mix of drugs that are suitable for you and do not necessarily include an anti-tnf. Unfortunately you will find that whilst there is masses of information out there it can be very conflicting, so use with caution. Please don't rush into things, as I said RA does not have a cure it is going nowhere, with the right treatment your doctors will get the disease under control. "Finally, I have read that drugs are the only cure for RA, but thinking of the film Lorenzo’s Oil," It is important that at this stage of your treatment you allow the doctors choice of medication to have effect. Please don't be tempted to throw in alternative therapies at this point as they may mask the reality of your situation. Many natural remedies are not recommended for RA and some actually react with the medication and can lead to kidney/liver problems, particularly so whilst taking methotrexate. Majority of natural remedies have not been tested and from what I recall the only one that is proven, for it's anti-inflammatory properties, is Omega 3 but that may contain Vitamin A which you have to watch out for. This may be a route to follow later but for now do take the advice of those treating you. They have years of knowledge and experience and are at the cutting edge of new developments. As I said last night I have had RA for 22 years, I had to take ill health retirement from a well paid senior management job and I was the single wage earner. It isn't easy but it is do-able and life can still be enjoyed. I have brought up four kids since starting with RA, life does not stop. The disease will be controlled but you need to be positive and meet it head on. You have done this by joining NRAS and now is the time to move forward armed with good knowledge from the experiences of those who live with the disease. It may take time to find what's right for you but you will get there, joint damage or not! We all have a serious illness, we can't opt out, it's sink or swim. BUT it can be an enriching experience. Stay positive. Perhaps speaking to a volunteer through NRAS would help you get a better perspective of things and answer other questions. Please thing about it. Sorry my comments may seem harsh but a diagnosis of RA is a wake up a call not a death sentence! Take care John and let us know how you get on. Lyn x
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Rank: Advanced Member
Groups: Registered
Joined: 12/3/2009
Posts: 351
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Hi John, As breadwinner and father, I can empathise with your situation and think it might help if some of our male members respond to your post. One member that springs to mind is Stewart, aka RedDog, he was diagnosed early 30's when he was a breadwinner and had young children ......... I'll ask him to post something on here. I was dx as a child, 39 years ago, and managed to work 22 years in an office environment, I'm not sure what type of work you do, is it something physical and strenuous? Hopefully once you're on the right drugs things will improve for you. Carol
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Rank: Advanced Member  Groups: Registered
Joined: 12/3/2009 Posts: 3,006 Location: Timperley
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Hi John
Welcome to the forum - the club no-one wants to join!
I can't really add to the excellent advice you have already been given, but wanted to say "hi".
I've been diagnosed for 7 years now and have found MTX injections and hydrochloroquine work well for me.
Keep posting and we look forward to getting to know you.
Love Jeanxx
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Rank: Advanced Member  Groups: Registered
Joined: 3/8/2010 Posts: 914
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Hi John, I remember this feeling so well, Its been like hit with a sledgehammer, My name is Lorna I have had RA for 3 years almost. I am married to, Ken and have 3 grownup daughters. I was on the triple therapy MTX, Hydrox, and Sulph, and Folic acid. Being diagnosed early on does make a difference but so does being positive. Like already said you have an illness not a death sentence. There are lots of drugs out there when you get the ones for you you will see a big difference. I am now in remission but just have to watch not to overdo things or I take 2 days to recover.  I know it's hard but keep in there it does get easier. I eat little red meat, eat lots of fruit and dark veg. My Rhummy says red meat puts up your inflammation level, so I stick to lighter colored meat. The omega 3 is good too, I take flax seed oil which has omega 3 in it. Good luck and try to be strong it will get easier. Lorna
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Rank: Advanced Member  Groups: Registered
Joined: 12/3/2009 Posts: 2,237 Location: nr Southampton
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hello John and welcome.
I am Jenni, 34, married with 3 children who are 15,12 and 2!
You have done really well to find the forum. There are lots of ways people use to cope with the RA, I like to be really informed about everything. Most patients do really well on the DMARDS (MTX, SLZ, hydroxycloroquine, leflunomide etc) and never need go near the Anti TNFs. Average RA looks a bit like this a few months of faffing trying to find a DMARD that really works for you. You stay on the one treatment for about 5 yrs occassional joint injections, blood tests and reviews inbetween. You then have a nasty flare and get in trouble so you see a rheumatologist who stabs you with steroid and add another medication into the mix. It takes a few months and then things settle off again. The medication is very good nowadays- people who have had RA for 20yrs are still working and doing well.
Sadly, I have severe disease and have been right through the DMARDS and the anti tnfs, plus the other biologics and I can tell you now these drugs have almost claimed my life. BUT when the disease as severe as mine is there is little choice. I got sick when I was 20, now have severe systemic disease- apparently only 3% get this bad- so it is VERY unlikely that you John will get this far. Also there is evidence that your gender is a protective factor as fewer men develop severe RA than women. Even with severe disease I worked for 10 yrs primary teaching.
I am 2 wks into a brand new drug called Cimzia (having sworn blind I would never go near the biologic types again) and to my absolute delight it seems to be working. I feel loads better! no allergic reactions/ side effects (yet). I am very aware that the risk of serious infection on the biologics is somewhere between 3-5 times greater than on DMARDS and yet I need some form of life and to halt the very fast deterioration in my physical condition following a very stressful time at home the last 6 mths or so.
Im sorry to tell you there is no cure for RA but the the drugs do slow the progress of the disease and help you feel loads better when you get the right one.
As for diets John, there are plenty of people out there very happy to deprive you of your hard earned cash selling mush in the hope of a "cure". As for evidence, there is some evidence that fish oils, ginger and tumeric can lessen inflammation, they do naff all against an auto immune disease. For some bizarre reason people seem to think RA is something to do with what you eat. A lot of RA patients do have stomach problems- this is largely because the drugs can mess up your guts and also the inflammatory processes can effect every part of your body including your tum. People often get ra after a big stress, hormonal change or viral illness there is no known cause to be honest no one is sure, genetics play a pre-disposed part. It is nothing to do with eating too much citrus fruit!
If there was a diet or supplement to help, every rheumatologist in the country would put you on it. If it upsets you, dont eat it- otherwise do your best to live well. Stop smoking (if you do- it will have a proven effect for the better on the ra) have the odd drink, eat balanced diet.
fatigue is hard to deal with- not sure what you do for a living but pacing yourself is something you will need to learn- I think a priority will be to see an Occupational therapist for an energy conservation review also give you practical tips/ equipment for managing your work.
If you are near london have a look at- St Thomas' and Guys- Dr Gabriel there is excellent I hear, they have a specialist unit just for rheumatoid there if you want a second opinion have a look there.
how are your family doing with the sudden change? Do you have sero positive or sero negative? Have your esr and crp come down since you have been on the drugs?
Jenni how to be a velvet bulldoser
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Rank: Advanced Member  Groups: Registered
Joined: 12/3/2009 Posts: 312 Location: Surrey
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Hi John, Sorry to hear of your condition....but there is light at the end of the tunnel. I developed RA and Diabetes after being injured at work. I was 30 at the time. I've had both for 24 years. There's been a lot of good advice given by the ladies on the forum. If, however, you wanted to talk to another bloke then you'd be welcome to contact me! I'm quite friendly! If you give NRAS a bell they'll forward on your number and I'll speak to you! I might even be able to give some advice about complimentary medicines! Stay strong Stewart. A friend is someone who knows all about you but loves you anyway!
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Rank: Member
Groups: Registered
Joined: 6/14/2010
Posts: 23
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Thank you everyone who has got back to me. That has all been really useful!  To answer some specific points: Lynn - I'm not insured, so can't really take time off, but I hear you - I have been taking things easy. I've had loads of rest over the past week and have slowed down my life tremendously. It's not been easy - I was very physically active and strong to begin with, but feel as though I'm literally half the man I was - muscle bulk, particularly in right arm has gone down as my right shoulder and wrist have been particularly bad. I used to cycle around 16 miles, and now can manage to cycle to the hospital - which is about a 4 mile round trip. I do still enjoy swimming, but I'm going less than I used to. I've thought about yoga (as I used to do this) but I can't lean on my wrists, but, perhaps I'll try the meditation. I do spend time relaxing, and life is good. I realise I am lucky with my family and have a good network of friends. NRAS has been great in terms of putting me in touch with someone who's helped me learn a fair amount very quickly & we have become good friends - so that's all great and sorry if I gave the impression I was a bit 'grim reaper' about the whole thing. - It's probably the medication and the blimmin' roller coaster they give you in terms of mood swings. It's a tad scary, but it is what it is... I am sero +ve. Jenni, you are a star, thank you for that. Guys & St Thomas' has been at the back of my mind - & I understand they have a good 'holistic' team. My ESR baseline was 33, went down to 12 after a month on depo-medrone injections and started at 7.5mg of Mthx, but within 2 weeks doubled and has been increasing steadily, despite increasing mthx. The CRP has been steadily rising - practically doubling each time and was at 26.4 at the end of last month. I guess it takes time to work and the steroid injections work pretty fast. I do wish you the very best. I wish you all the very best and glad I have found you all. May we all continue to help, support and share - especially given that there is a severe difference in quality of treatment around the country and even places that on the surface appear to be doing well are still falling short of the ideal. From what I've read, I'm beginning to think my health care team may be in the premier league (sorry to use footy analogy, but it is topical) but where they are in the table, I'm not too sure - mid(ish)? I can understand why people may not want to say where they are being treated, but, come on...there must be a beacon/s of clinical excellence out there. Where are they..? J
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Rank: Advanced Member  Groups: Registered
Joined: 12/3/2009 Posts: 1,110 Location: London
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John, re your last point, I am treated at Guy's. There are good consultants there, but I think its roughly the same in most areas. I am currently on triple therapy, was diagnosed July 2009. Was on mtx alolne for the first 9 months, then added hydroxy, and finally sulfa, plus the folic acid. Was also on pred, but have come off, and really feeling the difference. I dont feel it has all kicked in at the moment, as still getting lots of pain and swelling etc I still work full time caring for babies, so very physical and definitely becoming harder, I too am self employed, and my husband also has had to retire from work due to heatrt disease, diabetes and RA. I hope the meds work for you, and that youg et the right combination sorted. BARBARA
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Rank: Advanced Member
Groups: Registered
Joined: 5/19/2010
Posts: 384
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Hi John,
Sorry that you have had to join this club. I am still new to all this as well only being diagnosed seven weeks ago, but I believe MTX 20mg weekly is starting to kick in, have had less joint pain recently and blood tests looking much better. You receive so much good advice on here and it certainly helps you feel much better knowing you are not alone.
Anne
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Rank: Advanced Member  Groups: Registered
Joined: 12/3/2009 Posts: 1,582 Location: Oxfordshire
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Hi John,
Having come in on this thread very late everyone has said what I was going to say anyway!
Things will gradually ease for you when the meds begin to help- the MTX does take a long time to work but is the no1 med for RA currently.
I am one of the many people who have tried alternative remedies and take herbs for the RA but always with my rheumy's knowledge and along side medications.
The medical herbalist has helped the most but i was seen at the Royal Homeopathic Hospital for a year until i decided to cease going.
Take care,
Amanda
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Rank: Advanced Member  Groups: Registered
Joined: 12/4/2009 Posts: 856
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Hi John
Just picked up on this too- a warm welcome from me. I can't really add much more- I've had RA for 3 yrs , been up and down- had a good 18 months but now not so good, so on new meds which haven't kicked in yet!! I hate the unpredictability of it all- than god ness for the forum.
Take care
Maria x
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Rank: Advanced Member  Groups: Registered
Joined: 3/17/2010 Posts: 42
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Hi John Sorry to hear you have been diagnosed with RA. It is a shock to the system going from one day where you are relatively healthy and know which way you are heading in life to suddenly being hit with a chronic disease with the resulting change in lifestyle and life long medication. I was diagnosed around the same time as you. I started getting symptoms in December 09 and was diagnosed in March 10. I feel I was very lucky with my GP since she listened to my concerns and was quick to refer me to a rheumatologist at my local hospital. She was even happy to refer me on for a second opinion when I asked for it. I think one of the things which helped me to get a quick diagnosis is that I really was in touch with my body. Like you I used to do quite a bit of exercise so when I started getting some unusal aches and pains which I could not put down to exercise fatigue or anything else I quickly went to my GP and started hasselling her like mad. Anyway enough of how I was diagnosed since I think you want to know a little about the treatment which I am currently getting.  Shortly before my diagnosis (back in February 10) I was put on prednisolone. My GP put me on this because I was in such pain and was finding it difficult to carryout even simple movements. I then went to see the Rheummy for an initial consultation in March and I was given my RA diagnosis then. My hospital (Whipps Cross) is part of a research study which studies the effects of putting newly diagnosed patients onto anti-tnf's during the so called window of opportunity. The aim being to see if early aggressive treatment will slow down the progress of RA and keep people active and in work for a longer period of time. To be on the study you need to have been diagnosed with RA for less than 12 months and you should not have taken any of the DMARD or biologic drugs. Essentially you need to be a RA virgin. The study takes place for just over two years. I started the study 4 weeks ago and currently I am feeling great. I even managed to go out for a night out in my heals the other day (that probably means nothing to you but for me it was a nice feeling ). I am currently on 10mg of methotrexate, etanercept, folic acid and prednisolone (2.5mg having started with 5mg). I hope to be off the steroids in a couple of weeks time but I am currently being weaned off them. I felt the difference after 4 days of being on the study. I go in for regular blood tests and my rheummy nurse has given me her personal mobile number which I can use if I ever get into trouble so I do feel I am being looked after to date. Now I know that biologics aren't for everyone. I did do a lot of reading around the pros and cons of starting such drugs early and I will never know if my RA would have been controlled by using one of the more standard treatments first of all, but for me this has been the right choice. I just keep thinking back to the days earlier this year when I could barely walk or brush my teeth etc..... I can leave the study when I want but I shall try to stick with it for the timebeing. I hope my story has been of use to you. Given that you have already started your treatment you would not be eligible for the same study as me but there might be other studies around the country which might be suitable for you. Perhaps you could give the helpline a call. The reason I mention this is because a study might be one way of getting around the post code lottery if biologics are not available in your area. My study is not sponsored by the NHS but by a drug company so my drugs come direct from them. Let me know if you need any other info. Good luck Agnes
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