Hello Mary. This doesn't seem like the ideal experience at all. It's a shame that you were unable to ask questions and there was no time for anything but the basics. Unfortunately there don't seem to be enough rheumatologists, waiting lists are often long and certainly at my clinic the delays I have experienced (it's rare to be seen less than an hour after the allotted time) suggest a service under some strain. Do you know whether there is a specialist rheumatology nurse attached to the department where you were seen? It might be worth asking the secretary if there is one and you can channel any concerns and questions through him/her. At my hospital we have open telephone lines to the nurses on weekday afternoons and this has been so valuable and appreciated by me, especially as many GPs don't seem to be well versed in RA matters. The drugs you have been prescribed seem to be pretty standard for newly diagnosed patients so at least you will find people here who have taken them and can advise. Were you given folic acid too? I have never had a steroid injection, having always been given the oral steroid tablets so I can't advise on when to expect improvement but someone else will step in here I'm sure. I wish you luck with your treatment and hope that the Methotrexate works for you. It is a very powerful and successful drug which is why so many people are started off on it. We will be here to support you if you need it. Best wishes from Naomi.

Hi Mary

Your story is quite familiar these days as Rheumatology depts are overstretched and often inadequately staffed for the number of new referrals and ongoing patient assessments. It is far from ideal, but as the need for continuing aftercare grows it is something that, for now at least, we have to accept. Fortunately the number of RA treatments is increasing and improving and may long term require less follow up.

Often a steroid injection is given to control the symptoms of inflammation until such time as the Methotrexate takes effect. It can take a few days for the injection to work fully, and the advice is to rest for 48 hours to give it the best chance of success. The injection is normally either Depomedrone or Kenalog. For some people they work for 6/8 weeks but for others not at all. As an alternative oral steroids can be prescribed and these can be effective where the injection fails. I have always had success with oral tablets and none whatsoever with the injections (other than joint injections)! We are all different in our responses to drugs.

Methotrexate is the gold standard treatment for RA and many people find that this is sufficient to control the disease and bring about chemically induced remission. It is also the 'base' drug to which additional disease modifying drugs can be added if necessary. The folic acid helps to control some of the side effects of the Methotrexate but it is important that it is not taken on the same day as it can affect the uptake of the drug. There are different prescribing patterns for folic acid, some are given it to take on one day a week only and others will take it on six days a week.

Everyone on Methotrexate is required to have regular blood monitoring tests. These are dual purpose to check the efficacy of the medication and to check for possible complications in areas such as liver and kidney functions. You should have been given a shared care monitoring booklet to record the results of your blood tests which can then be taken with you to appointments. Methotrexate can take up to 3 months, sometimes a little longer, to work as it takes time for it to build up in your system.

If you have particular concerns or worries the NRAS telephone helpline is a useful source for information. Alternatively forum members have a wealth of experience that you can draw on so don't be afraid to ask! We've all been where you are now!

Hope you start to benefit from the steroid very soon,

Lyn x

Hi Tina,
Sorry to hear about your experience.
My RA is not as bad as yours, I was in a lot of pain but not to the extent you describe.
I was put on MTX starting at 10mg and increasing to 20mg.
As I increase my dose my blood tests showed my liver wasn't very happy, so have now been reduced to 10mg again.
The MTX does seem to be working and starting working quite quickly, I don't have much inflammation at the moment but my fingers are still fairly sore, I suppose due to the damage done before I started on medication. I still find I get very tired and as yet havent returned to my cycling/keep fit.
There are a lot of knowledgable people on the site, who have been through everything you could imagine.
I hope you start to feel some relief soon.
Hope to chat to you again.
Mary x

Hi Mary and a warm welcome to all you newcomers.
You are already finding how helpful this forum is for finding information and encouraging one another.

Mary, in your earlier post you said that you were trying to be referred to a hospital nearer home. I just wanted to say that I am seen at Queen Mary's Sidcup and the rheumatology department there is brilliant. I am under Dr Bamji but now that my RA is under control I am monitored by the Rheumatology Nurse who is also excellent. I can always ring her with queries and she always gets back to me promptly. Even though I have now moved, I have remained under their care and am happy to drive 50 miles each way to receive such excellent care.

Wishing you success with getting referred elsewhere and also hope that the relief of symptoms continues.

I have been diagnosed 6 years and am currently on Methotrexate and Enbrel.

Looking forward to hearing more from you all

Best Wishes

Sue