Hi Darshin,

I am new too, diagnosed 1 month ago, so far had 2 joint inj and waiting to start mtx on 6 june. No rheumatology nurse appt materialised so far despite supposigly having 1 sent within 2 weeks of seeing consultant (April11) I do have a fab GP though who is trying his level best to sort out my pain. Its funny really, I have gone from a sore wrist, to every part of me having pain in some way in just a month. The pain in my wrist (right, and I am right handed) is agonising. I know exactly how you feel though. It is a lot to take in, especially when you appear to have a new pain daily!!

I have found lots of support and encouragement on this site so far and I have only posted once, everyone here understands what us 'newbies' are going through in these early days so it is great to know we are 'normal' in terms of the disease process, I honestly thought I must imaging all the new symptoms at first.

Welcome to the site, I look forward to learning more about you. I am 48, married 3 grown up kids and 1 grandson, 2 further babies on the way in june and july so need to be out of pain to cuddle the new grandkids!!

Hi Darshin

My mxt was stopped twice. 1) because liver function test was high and 2) because I had a breathing problem and mxt can cause fibrosis. After the first one I was only off for one week could go back on after next test was ok. The second one was more problematic. I had to have a CT scan, chest x ray and by the time I got results from both mxt had worn off and I had the worst flare up ever. Fortunately breathing problem was not caused by mxt so was able to continue on it.

Sheila x

My mtx was stopped when I had an abnormal liver reading (they subtly asked me if i had been partying!) but that was just a blip and I was soon back on it.

My depo injections can last for about a fortnight and sometimes i don't feel any effect at all! There is no rhyme or reason with this RA!

Hello again..Quick update after seeing my (private) consultant this Friday after reviewing latest blood tests.

My ESR and CRP were high and gone up against the previous blood test. I was probably under influence of the 3rd depo-med injection on the older blood test.

The consultant has advised me to start on a 3rd DMARD drug sulfasalazine..which I took today. 2 x daily to start.

So now 3 DMARDS to get on with..

Also had an aspiration on my right knee - a tea cup worth's yellow/orange fluid removed and also a steroid injected into knee. Lot better now.

In fact today is the best I have felt in days. Even hands and fingers were great on wake up.

Wonder if the injection in knee can act across the body?

I also have my first NHS appointment here in Watford and am hoping that they will take over my case going forward.

Living in hope that surely 3 DMARDS must get me control of this horrible illness!.

Hope I haven't bored with this essay..

-Darshin
-- MTX, HCO and new Sulfasz

Hi Darshin,

Lovely to hear that you are feeling a bit better.
Yes, a steroid injection into the joint will get into the system , I have noticed this with joint injections.
Good luck with the sulphasalazine, I hope the combination of 3 DMARDs does the trick for you.

Doreen xx

hi Darshin,

pleased to hear you are feeling a bit better,

and good luck with the triple therapy .. you were able to start it early in England, as my 2 DMARDS were given 6 months apart although sadly failed.

still waiting to hear on the Humira.

Suzanne x

Hi Darshin

The approach your consultant has used is the one that is recommended ie combination therapy. Majority of practitioners use this method as it has been well researched, tried, tested and recommended.

I have explained this elsewhere but not sure where now! The method of combination therapy used in England is called the 'step up' method. One DMARD is introduced, often Methotrexate as this is sometimes enough on its own to slow the progression of the disease. Something we would all like with the minimum of drug intervention. If symptoms are not brought under control within 3/4 months a further DMARD is added to the mix to make a combination therapy. If necessary a further drug may be added to make a triple therapy. Each stage is initiated gradually so that at all times the efficacy of the regime can be adequately monitored. If side effects occur it is usually clear which drug is the culprit and just that one drug can be removed from the cocktail.

The method used in Scotland, certainly by Lorna's consultant, is the less frequently used 'step down' method. All three DMARDS, usually including methotrexate, are given at the outset. The idea being to hit the disease hard at the start. The snag with this is it can be very toxic on the bodily systems and if side effects occur, commonplace when so many new drugs are all introduced at once, all have to be stopped until things settle down.

In my opinion, and it is just that, it is not necessary to 'over treat' RA. It is a progressive disease, as I well know, but that progress is slow. Joint damage occurs over a long period of uncontrolled disease, years, not overnight or even months. A slowly built up drug regime will be more effective providing it is carefully controlled and monitored.

I have had combination therapy in the past which has worked well until such time as the drugs have lost their efficacy. This seems to be a feature of RA unfortunately and different drugs may need to be tried as a matter of routine. So, there is no cure yet but most people diagnosed and treated early enough will have a very acceptable prognosis with today's modern drugs and will live a fairly normal life with little or no joint damage. Sounds like your consultant has you heading in the right direction, fingers crossed for a good outcome.

Take care

Lyn x