DMARDs

January 15, 2003

I keep seeing this mentioned in the notes and am wondering what this is. Could

someone let me know?

I am still having lots of pain with my arthritis. I am on Enbrel, Arava, and

Vioxx. Have only been on the Arava for about 2 weeks. My main focal point is

my right foot although x-rays revealed I have joint erosions in both feet. Am

glad to be off the Prednison as I have gained so much weight with the difficulty

in moving and the wt gain it causes.

I try to keep a good outlook on things. I appreciate it when my husband asks

how I am doing but I have to admit that I sort of get tired of people asking

" how is the new med working " ?, or " why are you limping " ? I can't come up with

any new answers. I have just decided to say that things are the same and I am

trying to be positive about the situation.

Thank you to all who write in. I laugh, I ponder and I pray with all of you

when reading the posts.

Terri

January 15, 2003

<PRE>yes and they all have arthritis right?? i always loved that one!! hang in

there. kathy in il

February 9, 2004

Hello, Joanne!

There are very many choices for DMARD therapy today.

Here is an excellent article from the Hospital for Special Surgery by

Dr. Paget entitled, " New Standards of Treatment for Difficult

RA - Part 1 " :

http://rheumatology.hss.edu/phys/musings/pagetstandardsra.asp

On rheumatoid arthritis treatments from s Hopkins:

http://www.hopkins-arthritis.som.jhmi.edu/rheumatoid/rheum_treat.html

A CME unit from Medscape, " The Biologic Revolution in Rheumatoid

Arthritis: How TNF Antagonists Have Optimized RA Treatment and

Outcomes " :

http://www.medscape.com/viewprogram/2769

(Medscape registration is fast and free)

I can't help you from personal experience with hand surgery decisions,

but I'm hoping that some people here who have had procedures done on

their hands will share what they know with you.

" Rheumatoid Hand, " from eMedicine.com:

http://www.emedicine.com/plastic/topic475.htm

From the ARC, " Role of Surgery in Patients with Rheumatoid Arthritis " :

http://www.arc.org.uk/about_arth/med_reports/series3/pp/6342/6342.htm

From the Hospital for Special Surgery, " Surgery in the Patient with

Inflammatory Arthritis " :

http://orthopaedics.hss.edu/services/arthritis/surgeryArth/

On finger replacement surgery from DynoMed.com:

http://www.dynomed.com/encyclopedia/encyclopedia/hand_and_wrist/Finger_Arthropla\

sty_(Metacarpophalangeal_Replacement).html

Mayo Clinic: " New Artificial Knuckles Make Life Easier for Arthritis

Victims " :

http://www.mayoclinic.org/news2000-rst/613.html

" Responsiveness of the Cochin rheumatoid hand disability scale after

surgery " :

http://rheumatology.oupjournals.org/cgi/content/full/40/8/843

I'll tell you where to go!

Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org

[ ] DMARDS

> Can someone explain the progression of DMARDS medication?

>

> I have gone thru all the usual oral meds and either they are

> ineffective (cox-2 inhibitors) or I am allergic. The only one

> that really helped my pain was Placquenil, but developed an

> allergic reaction. Same with Quinacrine, Mobic and others.

>

> I then started Methotrexate weekly injections (avoided the oral

> route because of GI problems) and initially had some relief.

> After a couple months the pain crept back again, then my liver

> functions tests were off so the dose was decreased slightly.

> LFTs are still off so now rheumy added leukovorin. I don't

> feel any better after 2 weeks and am wondering what the next

> step may be. If I don't get some relief I will be considering

> fusion of some finger joints. This scares me because I would

> lose more time off work and concerned about loss of function/

> future employment issues. I'd appreciate any ideas and info on

> fusion of finger joints

>

> Joanne

February 9, 2004

Hi Joanne. I can only tell you the progression I have gone through.

I started having symptoms about a year and 4 months ago and when to

the rheumatologist pretty much right away due to an elevated RH

factor and the fact my mom has severe RA and lots of joint damage

(really, she has no joints anymore).

I was started on Bextra, was given samples then insurance would not

approve it so switched to Vioxx. Vioxx didn't really work so then

insurance would pay for Bextra, but then Bextra didn't work anymore

either because things were getting worse. I went on prednisone for a

while and then when the rheumatologist decided to officially diagnose

me (last summer, things again were progressing), he put me on

methotrexate in addition to the prednisone. We tried to decrease the

prednisone but I could not get below 5 mgs. I had a flare starting

at Christmas and he prescribed Humira. Now I am on Humira,

methotrexate and prednisone. The idea is to get off the predisone

very soon, and decrease the methotrexate but stay on it. I am doing

very well with the Humira.

My mom had her toe bones fused but it lasted less than a year. The

constant walking (people tend to do that) caused the fusion to weaken

and come apart, so she went through all that surgery and pain for

nothing. Plus having them fused made walking quite difficult (it's

hard to walk without bending your toes). She has tried lots of

things over the years but she would not try fusion surgery again

(because it was not successful long-term). I think a lot depends on

your level of joint damage. She pretty much has no joints left in

her hands and feet. I would do more research before undergoing the

surgery though. I know it's toes not finger joints, but thought you

might like the information.

Jenne